(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "The American journal of the medical sciences"




ElilFf-'* 



Ha 






sii 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



No. XV — May, 183-1. 1 



COLLABORATORS. 



Jacob Bigelow, M. D. Professor of 
Materia Medica in Harvard Univer- 
sity, Boston. 

Edward H. Barton, M. D. of St. 
Francisville, Louisiana. 

Walter Chaining, M. D. Professor of 
Midwifery and Legal Medicine in 
Harvard University, Boston. 

N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 

John Redman Coxe, M. D. Professor 
of Materia Medica and Pharmacy in 
the University of Pennsylvania. 

William C. Daniell, M. D. of Savan- 
nah, Georgia. 

William P. Dewees, M. D. Adjunct 
Professor of Midwifery in the Univer- 
sity of Pennsylvania. 

S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of S. Carolina. 

C. Drake, M. J), of New York. 

Benjamin W. Dudley, M. D. Profes- 
sor of Anatomy and Surgery in Tran- 
sylvania University. 

Gouverneur Emerson, M. D. of Phila- 
delphia. 

Thomas Fearn, M. D. of Alabama. 

John W. Francis, M. D. Professor 
of Obstetrics and Forensic Medicine 
in Rutgers Medical College, New 
York. 

E. Geddings, M. D. Lecturer on Anato- 
my and Surgery, Charleston, South 
Carolina. 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 
vania. 

R. E. Griffith, M. D. of Philadelphia. 

E. Hale, M. D. of Boston. 

Robert Hare, M. D. Professor of Che- 
mistry in the University of Pennsyl- 
vania. 

Isaac Hays, M. D. one of the Surgeons 
of the Pennsylvania Infirmary for 
diseases of the Eye and Ear. 

George Hat ward, M. D. of Boston. 

Thomas Henderson, M. D. Professor 
of the Theory and Practice of Medi- 



cine in the Columbian College, Dis- 
trict of Columbia. 

William E. Horner, M. D. Adjunct 
Professor of Anatomy in the Univer- 
sity of Pennsylvania. 

David Hosack, M. D. Professor of the 
Institutes and Practice of Medicine in 
Rutgers Medical College, New York. 

Ansel W. Ives, M. D. of New York. 

Samuel Jackson, M. D. Assistant to the 
Professor of the Institutes and Practice 
of Medicine and Clinical Practice in 
the University of Pennsylvania. 

Samuel Jackson, M. D. of Northum- 
berland, Pennsylvania. 

C. B. Matthews, M. D. of Philadel- 
phia. 

Valentine Mott, M. D. Professor of 
Pathological and Operative Surgery 
in the College of Physicians and Sur- 
geons, New York. 

James Moultrie, Jr. M. D. of Charles- 
ton, S. C. 

Reuben D. Mussey, M. D. Professor 
of Anatomy and Surgery in Dart- 
mouth College, New Hampshire. 

James M. Pendleton, M. D. Lecturer 
on Midwifery and Diseases of Women 
and Children, New York. 

Philip Syng Physick, M. D. Profes- 
sor of Anatomy in the University of 
Pennsylvania. 

Nathaniel Potter, M. D. Professor of 
the Theory and Practice of Medicine 
in the University of Maryland. 

D. L. Rogers, M. D. of New York. 
Thomas Sewall, M. D. Professor of 

Anatomy and Physiology in the Co- 
lumbian College, District of Colum- 
bia. 

John Ware, M. D. of Boston. 

John C. Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

J. Webster, M. D. Lecturer 07i Ana- 
tomy and Surgery, Philadelphia. 

N. W. Worthington, M. D. Professor 
of Materia Medica in the Columbian 
College, District of Columbia. 

Thomas H. Wright, M. D. Physician to 
the Baltimore Alms-House Infirmary. 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



VOL. VIII. 



PHILADELPHIA: 
CAREY & L.EA 

1831. 



5 $\THSG/y^ x 




i/BRAR* .*> 




fleck 



TO READERS AND CORRESPONDENTS, 



Drs. Horner, Geddings, Hamilton and Rankin's communications have been 
received. 

We have received the following works — 

The Dublin Medical Transactions, a series of papers by Members of the As- 
sociation of Fellows and Licentiates of the King- and Queen's College in Ireland. 
New Series. Vol. I. P. I. Dublin, 1830. (From the Society.) 

Therapeutique de la Phthisis Pulmonaire, suivie de notes, lo. Sur la me- 
thode de Dzondi et le treatment de la Syphilis en general; 2o. Sur le treat- 
ment du Typhus. Par A. Harel du Tancrel. Paris, Rouen freres, 1830. 

Practical remarks on the nature and effects of the expressed oil of the Cro- 
ton Tiglium, with cases illustrative of its efficacy in the cure of various diseases. 
By Michael John Short, M. D. London, 1830. (From the author.) 

Hints for Naval Officers cruising in the West Indies. By Wi. P. C. Barton, 
M. D. (From Carey & Hart. ) 

The Pharmacopoeia of the United States of America. By authority of the 
National Medical Convention, held at Washington, A. D. 1830. Philadelphia, 
John Grigg, 1831. (From the publisher.) 

An Essay on the History, Preparation, and Therapeutic uses of Iodine. By 
Samuel J. Hobson, M. D. (From the author.) 

A Treatise on Surgical Anatomy. By Abraham Colles, one of the Profes- 
sors of Anatomy'and Surgery in the Royal College of Surgeons in Ireland, &c. 
second American edition, with notes, by J. P. Hopkinson, M. D. Demonstra- 
tor of Anatomy in the University of Pennsylvania, and Lecturer on Anatomy in 
the School of Medicine. Philadelphia, Carey & Lea, 1831. 

Manual of Pathology; containing the symptoms, diagnosis, and morbid cha- 
racters of diseases, together with an exposition of the different methods of ex- 
amination, applicable to affections of the head, chest and abdomen. By L. 
Martinet, M. D. P. Resident Physician of the Hotel Dieu. Translated with 
notes and additions by Jones Qtjain, A. B. Demonstrator of Anatomy at the 
Medical School, Aldergate street. Second American edition. Philadelphia, 
Carey & Lea, 1830. (From the publishers.) 

Lectures on Inflammation, exhibiting a view of the general doctrines, patho- 
logical and practical, of Medical Surgery. By John Thomson, M. D., F. R. S. E. 
Professor of Surgery to the Royal College of Surgeons, and Regius Professor of 
Military Surgery in the University of Edinburgh. Second American from the last 
London edition. Philadelphia, Carey & Lea, 1831. (From the publishers.) 

An Eulogy on Dr. Godman, being an introductory lecture, delivered Novem- 
ber 1, 1830. By Thomas Sewael, M. D. Professor of Anatomy and Physiolo- 
gy in the Columbian College, D. C. Washington, 1830. (From the author.) 

Report of the Select Committee of the House of Representatives, on so much 
of the Governor's speech at the June session, 1830, as relates to legalizing the 
study of Anatomy. Boston, 1830. (From Professor J. C. Warren.) 

An Oration delivered before the Philadelphia Medical Society, Feb. 19, 1831. 
By Thomas Harris, M. D. &c. (From the author.) 



6 TO READERS AND CORRESPONDENTS. 

An act to incorporate Medical Societies, for the purpose of regulating the 
practice of Physic and Surgery in Ohio. The Constitution and By-laws of the 
General Medical Society, &c. Steubenville, 1831. (From the society.) 

A Charge addressed to the Graduates in Medicine of the University of Penn- 
sylvania, at the public commencement held in the College Hall on Thursday, 
March 24, 1831. By William H. De Lancet, D. D. Provost of the University. 
Published by the request of the class. (From the author.) 

The London Medical and Surgical Journal, for November and December, 
1830, and January, 1831. (In exchange.) 

The London Medical and Physical Journal, for November and December, 
1830, and January, 1831. (In exchange.) 

The Midland Medical and Surgical Reporter, for November, 1830. (In ex- 
change.) 

The Glasgow Medical Journal, for August, 1830. (In exchange.) 

The Medico-Chirurgical Review, for January, 1831. (In exchange.) 

The Edinburgh Medical and Surgical Journal, for January, 1831. (In ex- 
change.) 

The London Medical Gazette, for December, 1830, and January, 1831. (In 
exchange.) 

Annalesde la Medecine Physiologique. Par F. J. V. Brotjssais. September, 
October, November, 1830. (In exchange.) 

Journal Universel et Hebdomadaire de Medecine et de Chirurgie pratiques 
et des institutions Medicales. Tom. I. Nos. 8, 9, 10, 11, 12, 13. (In exchange.) 

Journal de Chimie Medicale de Pharmacie et de Toxicologic. November and 
December, 1830, and January, 1831. (In exchange.) 

Revue Medicale Francaise et Etrangere. October, November, December, 

1830. (In exchange.) 

Bulletin des Sciences Medicales. August, September, 1830. (In exchange.) 
Gazette Medicale de Paris. November, December, 1830, and January, Feb- 
ruary, 1831. (In exchange.) 

Archives Generates de Medecine. November, December, 1830, and January, 

1831. (In exchange.) 

Transactions Medicales. November, December, 1830. (In exchange.) 

The North American Medical and Surgical Journal. January and April, 
1831. (In exchange.) 

The Transylvania Journal of Medicine and the Associate Sciences, for No- 
vember, 1830. (In exchange.) 

The Western Journal of the Medical and Physical Sciences. January, 1831. 
(In exchange.) 

The New York Medical Journal, for February, 1831. (In exchange.) 

The Boston Medical and Surgical Journal, Vol. IV., Nos. 1 to 9. (In ex- 
change.) 

For the gratification of our contributors we present references to the works 
received during the last three months, in which their communications are no- 
ticed. 



TO READERS AND CORRESPONDENTS. 7 

Professor Mott's Case of Aneurism, treated by tying the artery beyond 
the tumour, is noticed in Gerson and Julius's Magazin, for September and Oc- 
tober, 1830; his case of Extirpation of the Clavicle, in the same Journal, for 
March and April; his case of Immobility of the Lower Jaw, in the same Jour- 
nal, for July and August, 1830; and his case of Ligature of the Subclavian, in 
the North American Medical and Surgical Journal, for April, 1831. 

Professor Jackson's Observations on the Pulse and its Modifications, are no- 
ticed in the London Medical and Surgical Journal, for November, 1830; and 
his case of Amnesia is copied into the Gazette Medicale de Paris, for January, 
1831. 

Professor Dickson's Case of Amnesia is copied in the Boston Medical and 
Surgical Journal, for April, 1830. 

Professor Horner's Case of Ozena, cured by the Chloride of Lime, is copied 
into the Archives Generales, for January, 1831. 

Professor Mussey's Case of Anastomosing Aneurism, is noticed in the Glas- 
gow Medical Journal for August, and in Gerson and Julius's Magazin, for Octo- 
ber, 1830. 

Dr. Drake's Experiments on Respiration of Cool Air in Pulmonary Diseases^ 
are noticed in the Gazette Medicale, for January, 1831. 

Dr. Jackson's Observations on the use of Rhubarb in Haemorrhoids, are no- 
ticed in the Archives Generales, for January, 1831. 

Dr. Barton's Operation for the removal of a portion of the Lower Jaw, by a 
longitudinal section, is noticed in the Boston Medical and Surgical Journal, for 
March, and in the North American Medical and Surgical Journal, for April, 183L 

Dr. Geddings' Remarks on the use of the Oleum Terebinthinse, as a remedy 
for Salivation, is copied into the Transylvania Journal, for November, and .lis 
Observations on the use of Strychnine in Paralysis, are noticed in the North 
American Medical and Surgical Journal, for April, 1831. 

Dr. Ware's Case of Organic Disease of the Brain, is noticed in Gerson aid 
Julius's Magazin, for September and October, 1830, and his Case of Sea Sick- 
ness in the same Journal, for August, 1830. 

Dr. Mitchell's paper on Penetrativeness of Fluids, is noticed in the Norti 
American Medical and Surgical Journal for January, and in Silliman's Journal 
for July, 1831. 

Dr. Randolph's Case of Amputation of the Jaw, is noticed in Gerson ani 
Julius's Magazin, for July and August, 1830. 

Dr. Moore's Case of Monster, is noticed in Gerson and Julius's Magazin, fo? 
May and June, 1830. 

Dr. Howe's Case of Tracheotomy is noticed in Gerson and Julius's Magazin, 
for September and October, 1830, and his Operation for Hare Lip, is copied intc 
the Boston Medical and Surgical Journal, for March, 1831. 

Dr. Bellinger's Remarks on Laryngotomy in Trismus Nascentium, is no- 
ticed in the North American Medical and Surgical Journal, for January, *1 831. 

Dr. Hitch's Case of Irritation of the Spinal Cord, is copied into the Boston 
Medical and Surgical Journal, for February, 1831. 



S TO READERS AND CORRESPONDENTS. 

Dr. Hendrie's Case of Euptured Uterus, is noticed in the Revue Medicale, 
for November, 1830. 

Dr. Lehman's Remarks on Otitis, are noticed in the Bulletin des Sciences 
Medicales, for August, 1830, and his Case of Voluntary Dislocation of Os Hume- 
ri, in Gerson and Julius's Magazin, for January and February, 1830. 

Dr. Carter's Observations on Mania a Potu, are noticed in the London Medi- 
cal and Physical Journal, for January, 1831. 

Dr. Lindsly's Case of Extirpation of a Cancerous Eye, is noticed in the Lon- 
don Medical and Physical Journal, for January, 1831. 

Dr. Fahnestock's Remarks on the use of Compound Tincture of Benzoin, as 
a Remedy for Scalds, are copied into the London Medical and Physical Jour- 
nal, for January, and his Observations on Endermic Medication, are noticed 
in the North American Medical and Surgical Journal, for April, 1831. 

Dr. Dakin's Remarks on the use of Arsenic, in large doses are noticed in 
the London Medical and Physical Journal, for January, 1831. 

Dr. Dickinson's Case of Wound of Femoral Artery, is noticed in Gerson and 
Julius's Magazin, for September and October, 1830/ 

Dr. Hall's Case of Lacerated Wound of Rectum and Bladder, is noticed in 
Gerson and Julius's Magazin, for July and August, 1830. 

Dr. Proudfoot's Case of Fistula, is noticed in Gerson and Julius's Magazin, 
for January and February, 1830. 

Br. White's Case of Compound Dislocation of the Ankle Joint, is noticed in 
Gepson and Julius's Magazin, for January and Februar}', 1830. 

Dr. Webber's Case of Cynanche Tonsillaris, is copied in the Boston Medical 
ani Surgical Journal, for March. 

Dr. Cartwright's Account of a Contrivance for Draining the Thorax of Li- 
qiiids, is copied into the Boston Medical and Surgical Journal, for March. 

Dr. Valks's Case of Pertussis, is copied into the Boston Medical and Surgi- 
cal Journal, for April. 

Authors of new medical books, desirous of having them reviewed or noticed 

this Journal at the earliest opportunity, are invited to transmit to the Editor 
a'copy as soon after publication as convenient, when they will receive prompt 
attention. Under ordinary circumstances, very considerable delay is caused by 
tjie circuitous routes through which they are received. 

, Papers intended for publication, should be sent, free of expense, as early after 
"tjie appearance of the Journal as possible, in order to be in time for the ensuing 
number. Such communications should be addressed to " Cabey & Lea, Phila- 
delphia, for the Editor of the American Journal of the Medical Sciences," or may 
|e deposited with Professor J. C. Warren, M. D. Boston — C. Drake, M. D. 
tfew York, or Professor S. H. Dickson, M. D. Charleston, S. C. 
/ All letters on the business of the Journal to be addressed exclusively to the 
publishers. 



CONTENTS 



ORIGINAL COMMUNICATIONS. 

ESSAYS. 
Art. Page. 

I. Reports of Cases treated in the Baltimore Alms-house Infirmary. By 
Thomas H. Wright, M. D. Physician to the Institution - - 17 

II. Description of the Circulation of the Head and Neck in a Case after 
one Carotid Artery had been Tied. By Valentine Mott, M. D. Professor 
of Surgery in the College of Physicians and Surgeons of New York. 
[With two Plates.] 45 

III. Case of Cancer cured by repeated Excisions and a Diet of Indian 
Corn, Zea mays, Linn. By Leonard Peirce, M. D. of Sutton, Mass. 49 

IV. On a New Practice in Acute and Chronic Rheumatism. By J. K. 
Mitchell, M. D. one of the Attending Physicians of the Pennsylvania 
Hospital 55 

V. Observations on the Use and Advantages of the Actual Cautery, with 
Cases. . By Alexander E. Hosack, M. D. (Read before the Medical and 
Philosophical Society of New York, Jan. 1831) - 64 

VI. Account of the Epidemic Scarlatina Anginosa which prevailed at 
Pittsburgh, Penn. in 1830. By D. Callaghan, Licentiate of the Faculty 
of Physicians and Surgeons, and Member of the Faculty of Medicine of 
Glasgow, and President of the Pittsburgh Medical Society - - 71 

VII. Topographical Remarks on the Climate, Soil, he. of the Middle Sec- 
tion of Alabama, more especially in Relation to the County of Dallas. 

By J. W. Heustis, M. D. of Cahaba 75 

VIII. Medical Cases. By J. Franklin Vaughan, M. D. Physician to the 
Alms-house of New Castle County, at Wilmington, Delaware - 94 

IX. Observations on Vision. By Benjamin F. Joslin, M. D. Professor of 
Mathematics and Natural Philosophy in Union College, Schenectady, 
New York 100 

X. Observations on the Gangrenous Sore Mouth of Children. By Jesse 
Young, M. D. of Chester, Penn. - - . - - - - - 106 

MEDICAL EDUCATION AND INSTITUTIONS. 

XI. An Account of the Origin, Progress, and Present State of the Medical 
School of Paris ---------- 109 

REVIEWS. 

XII. A Treatise of Pathology and Therapeutics. By John Esten Cooke, 
M. D. Professor of the Theory and Practice of Medicine in Transylvania 
University. In three volumes; Vols. I. and II. (Volume III. unpublished.) 
8vo. Lexington, 1828 125 

XIII. The Pharmacopoeia of the United States of America. By Authority 



10 CONTENTS. 

of the National Medical Convention, held at Washington, A. D. 1 830. 
Philadelphia, John Grigg, 1831. 
The Pharmacopoeia of the United States of America. By Authority of the 
General Convention for the formation of the American Pharmacopoeia, 
held in 1830. New York, S. Converse, 1830 141 

XIV. Exposition des Principes de la Nouvelle Doctrine Medicale, avec un 
precis des theses soutenues sur ses differentes parties. Par J. M. A. 
Goupil, Docteur en Medecine de la Faculte de Paris, Demonstrateur a 
1'Hopital Militaire de Toulouse, Sec. &c. &c. 8vo. pp. 603, Paris, 1824. 

Exposition of the Principles of the New Medical Doctrine. By J. M. A. 
Goupil, D. M. P. &c. 156 

BIBLIOGRAPHICAL NOTICES. 

XV. An Eulogy on Dr. Godman, being an Introductory Lecture, delivered 
November 1, 1830. By Thomas Sewall, M. D. Professor of Anatomy and 
Physiology in the Columbian College, D. C. Washington, 1830, pp. 24, 
8vo. - 187 

XVI. Dublin Medical Transactions, a series of papers by Members of the 
Association of Fellows and Licentiates of the King and Queen's College 
of Physicians in Ireland. New Series. Vol. I. Pt. I. Dublin, 1830. 
pp. 383, 8vo. Plates III. 192 

XVII. Therapeutique de la Phthisie Pulmonaire, suive de notes — lo. Sur 
la Methode de Dzondi, et le traitement de la Syphilis et general; 2o. 
Sur le traitement du Typhus. Par A. Harel Du Tancrel. Paris, 1830. 
8vo. pp. 107. 

On Phthisis Pulmonalis, &c. By A. H. Du Tancrel 200 

XVIII. Manuale di Anatomia Fisiologica Del Dottore Luigi Rolando, Pro- 
fessore de Anatomia nella R. Universita di Torino, Concigliere Straordi- 
nario del Magistrate del Protomedicato, &c. &c. Tradotta ed Arrichita 
di molte Annotazioni dal Dottore in Medicina, Giovanni Meloni Baile. 
Volume Unico. Milan, 1829, pp. 338. 

Manual of Physiological Anatomy. Translated from the original Latin of 
Professor Luigi Rolando, by Giovanni Meloni Baile, M. D. &c. - 203 

XIX. Anthropogenese ou Generation de l'Homme, avec des vues de 
Comparison sur les Reproductions des trois regnes de la Nature, et des 
Recherches sur la Conversation des Especes et des Races, les ressem- 
blances sexuelles des autres, le Croisement des Races, les Causes de la 
Fecondite, de la Sterilite, de l'Empuissance et sur d' Autres Phenomenes 
des Revivifications Naturelles. Par J. B. Demangeon, M. D. &c. &c. 
Paris, 1829. pp. 346. 8vo. 

On Generation, &c. By J. B. Demangeon, M. D. &c. - - - 204 

XX. Darstellung blutiger heilkunstlerischer Operationen, als Leit faden 
zu seinen Academischen Vorlesungen und fiir operirende Heilkunstler, 
bearbeitet. Von Christoph. Bonifacius Zang, der Chirurgie und Medicin 
Doctor, Sr. k. k. apost. Majestat Rathe, ordentlichem offentlichem 
Lehrer der Chirurgie, &c. Ester band, Dritte Auflage, Wien, 1823. 
Zweyter Band, 1824. Dritter, vierter, und fiinfter Band, 1818-19-21. 
Mit kupfertafeln, &c. 

Treatise on Surgical Operations, designed as a text book for the author's 



CONTENTS. 11 

Academical Lectures, &c. By Christopher Boniface Zang, Doctor of 
Surgery and Medicine, &c. 5 vols. Vienna, 1823-24 - - - 206 

XXI. Instructions and Observations concerning the use of the Chlorides of 
Soda and Lime. By A. G. Labarraque, Member of the Royal Academy 
of Medicine of Paris. Translated by Jacob Porter, Member of the Ame- 
rican Antiquarian and Geological Societies, &c. &c. New Haven, 1829, 
pp. 22, 8vo. 

Method of using the Chloride of Soda, either for Dressing Ill-conditioned 
Sores, or as a means of Purifying Unhealthy Places, and of Disinfecting 
Animal Substances. By A. G. Labarraque, &c. &c. Translated by Jacob 
Porter, &c. &c. New Haven, 1830, pp. 7 ..... 207 

XXII. Nuovi Elementi di Anatomia, ad uso delle Scuole di Floriano Cal- 
dani. Tom. primo e secwndo, pp. 806. Bologna, 1827. 

Elements of Anatomy, for the use of Students. By Floriano Caldani, 2 
vols. Bologna, 1827 210 

XXIII. Lehrbuch der Pathologischen Anatomie des Menschen und der 
Thiere. Von Dr. Adolph Wilhelm Otto, Koniglichem Medicinabrathe 
in Medicinal collegium f iir Schleisen, ordentlichem Professor der Medicin 
an der Universitat und der Medicinischen Chirurgischen Lehranstalt zu 
Breslau, &c. &c. Erster Band. pp. 472, Berlin, 1830. 

Elements of Pathological Anatomy of Man and Animals. By Adolph Wil- 
helm Otto, M. D. &c. 1st vol. Berlin, 1830 211 

XXIV. The Influence of Climate in the Prevention and Cure of Chronic 
Diseases, more particularly of the Chest and Digestive Organs: com- 
prising an Account of the Principal Places resorted to by Invalids in 
England, the South of Europe, &c; a Comparative Estimate of their 
Respective Merits in Particular Diseases, and General Directions for In- 
valids while Travelling and Residing Abroad. With an Appendix, con- 
taining a Series of Tables on Climate. By James Clark, M. D. Member 
of the Royal College of Physicians of London, &c. 8cc. Second Edi- 
tion, enlarged. London, 1830, pp. 400, 8vo. - - - - 212 

XXV. Elements of General Anatomy, or a Deseription of every kind of 
Organs composing the Human Body, by P. A Beclard, Professor of 
Anatomy of the Faculty of Medicine of Paris. Preceded by a Critical 
and Biographical Memoir of the Life and Writings of the author, by 
Ollivier, M. D. Translated from the French, with notes, by Joseph 
Togno, M. D. Member of the Philadelphia Medical Society, pp. 541. 
Philadelphia, Carey & Lea, 1830 ..-.-., $. 

XXVI. Sketches of the Character and Writings of Eminent Living Surgeons 
and Physicians of Paris. Translated from the French of J. L. H. P. by 
Elisha Bartlett, M. D. Boston, 1831 213 

XXVII. Encyclopadisches Woterbuch der Medicinischen Wissenchaften 
herausgegeben von den Professor en der Medicinischen Facultat Zu 
Berlin: D. W. H. Busch, C. F. V. Graefe, C. W. Hufeland, H. F. Link, 
K. A. Rudolphi. Fumfler Band. (Bandage— blutfluss.) Berlin, 1830 

Encyclopaedia of Medical Sciences. By the Professors of the Medical Fa- 
culty of Berlin. Vol. V. - - - 214 



12 



CONTENTS. 



QUARTERLY PERISCOPE, 

FOREIGN INTELLIGENCE. 



Anatomy. 



Page. 

1. Malformation of the Eyes. By- 
Professor Marse - - 215 

2. Metallic Mixture for injecting 
Anatomical Preparations - ib. 



Page. 

3. Congenital absence of the Iris. 

By Dr. Hentzschel - - 215 

4. Nerves of the Cornea. By Pro- 
fessor Schlemm - - ib. 



Physiology. 



5. Experiments on Pulmonary Ab- 
sorption and Exhalation. By 

M. Collard de Martigny 216 

6. On Animal Heat. By Drs. 
Graves and Stokes - - 218 

7. On Circulation in Vegetables. 

By Dr. Schultz - - ib. 



8. Mutual Action of Blood and 
Atmospheric Air. By Professor 
Christison - 

9. Seat of the Sense of Taste. By 
MM. Guyot and Admyrauld 

10. Brown's Moving Molecules. 
By M. Muncke 



Pathology. 



11. Cause of Stammering. By Mar- 
shall Hall, M. D. 

12. Nature of Diseases. By M. 
Sertueryner 

13. Case of Cancer of the Stomach 
with Perforation 

14. Case of Rupture of the Spleen 

15. Gaseous Tumours of the Ute- 



16. Case of Sub-maxillary Tumour 
produced by a hog's bristle in 
the Canal of Wharton. By M. 
Robert - 

17. Case of Bloody Sweat, occur- 
ring during the Hysteric Pa- 
roxysm. By M. Chauffard 

18. Case of Softening of the Right 
Optic Thalamus, with Paralysis 
of the whole of the left side of 
the Body. By M. Guersent 

19. Small-pox Infection communi- 
cated to the Foetus in Utero with- 
out the Mother feeling any in- 



220 
223 

ib. 

ib. 

ib. 



224 



ib. 



ib. 



disposition from its action on her 
own Constitution - » . - 

20. Case of Putrefactive Disor- 
ganization of the Lungs. By 
Robert Law, A. M., M. B. 

21. Case of Hxmatemesis depend- 
ant upon disease of the Liver. 
By Robert Law, A. M., M. B. 

22. Case of Ossification of the Mi- 
tral and Aortic Valves, with In- 
duration of the Tricuspid,' Hy- 
pertrophy and Dilatation of both 
Auricles, Ventricles sound. By 
Patrick Clinton - - 

23. Case of Attempt at Suicide, 
with Danger of Suffocation by 
the Falling Down of the Epi- 
glottis. By John Houston, Esq. 

24. Internal Strangulation of the 
Bowels after Parturition. By 
John Houston, Esq. - 

25. Case of Rupture of a vessel in 
the Brain from a Shock. By 
Charles Bell, Esq. 



219 



ib. 



220 



225 



226 



227 



ib. 



229 



230 



ib. 



Materia Medica. 



26. OnSalicine. By MM. Pelouze 
and Jules Gay Lussac - 231 

27. JEtherous Extract of the Se- 
men Santonici as a Vermifuge. 
ByM.Jehn 232 



28. The Ointment of Mezereon as 
a Dressing to Maintain a Perma- 
nent Discharge from Issues, &c. 

By Professor Hufeland - 232 

29. New Styptic. By M. Bonafous ib. 



CONTENTS. 



13 



Practice of Medicine, 



Page. 
By Dr. 



30. On Chronic Gastritis. 
Elliotson - 

31. On Paralysis Agitans. By Dr. 
Elliotson - - - - 

32. Chloride of Lime in Pectoral 
Disease, with great Fator of 
Breath and Expectoration. By 
Drs. Graves and Stokes 

33. Delirium Tremens. By Pro- 
fessor Speranza - 

34. Catalepsy accidentally cured 

35. Chloride of Lime in Gonor- 
rhoea. By Dr. Edward Graefe 

36. Tetanus and Neuralgia Treat- 
ed by the External Application 
of the Acetate of Morphium. 
By Dr. Gaspard Cerioli 

37. Sulphuret of Potassa in Croup. 
By Dr. Fritz e - 

38. A Case of Involuntary Con- 
tractions of the Muscles Cured 



232 



236 



239 

ib. 

ib. 

ib. 



240 



241 
ib. 



ib. 



Page 
by the Employment of the Hy- 
drocyanate of Zinc. By Dr. 
Klokow .... 

39. Perforation of the Stomach 

40. Nitro-muriatic Pediluvije in 
Engorgements of the Liver and 
Spleen. By Dr. Tannini 

41. Treatment of Epilepsy by re- 
peated doses of Ipecacuanha. 
By Dr. Ferrara 

42. Treatment of Scrofula with 
Iodine. By M. Lugol 

43. Hydrophobia Successfully 
Treated. By M. Ozanam 

44. Savine as a remedy in Chronic 
Passive Uterine Haemorrhages. 
By Dr. Feist 

45. Efficacy of Hydrocyanic Acid 
in curing Vomiting not Depend- 
ent upon Inflammation. By Dr. 
Elliotson - 



ib. 



h. 



242 



lb. 



Ophthalmology. 



46. Purulent Ophthalmia treated 
with Iodine. By M. Lugol 244 

47. Cataract cured by the Juice of 
the Anagallis Phenicoflora. By 

M. Ozanam ... ib. 



48. Cases of Amaurosis success- 
fully treated. By Dr. Buzzi 244 

49. Inflammation of the Ciliary 
Ring. By Dr. Ammon - ib. 



Surgery. 



50. Laryngotomy successfully per- 
formed in a Female affected with 

a large Goitre. By M. Willaume 245 

51. Internal Strangulation. By Dr. 
Larussac ... - ib. 

52. Radical Cure of Hernia. By 
Dr. Ravin - - - ib. 



53. New Method for the cure of 
Hernia. By M. Belmas - 246 

54. On Lithotrity. By M. Civiale ib. 

55. Section of the Sciatic Nerve. 

By Dr. Malagodi - - 247 

56. Wound of the Pericardium 
and Heart. By M. Larrey ib 



Midwifery. 



57. Vagitus Uterinus. By M. 
Baudelocque ... 248 

58. New Symptom of Pregnancy 
previously to the Fourth Month. 

By M. Beccaria - - ib. 

59. Cesarean Operation, by which 



both Mother and Child were 
saved. By Dr. Fr. Johanknecht 248 
60. A Case in which the Frag- 
ments of a Child were discharg- 
ed per Anum. By Dr. Boo- 
gaard ib, 



61. Poisoning by the Topical Ap- 
plication of Arsenic. By Dr. 
Fristo 249 

No. XV.— May, 1831. : 



Medical Jurisprudence. 

62. Poisoning with Coal Gas 



249 



14 



CONTENTS. 



Medical Statistics. 



Page. 

63. Report of the Coombe Lying- 
in Hospital. By Richard Reed 
Gregory, Esq. - - - 250 

64. Influence of certain occupa- 
tions on the development 'of 



Pa&e. 
Phthisis Pulmonalis. By M. Be- 
noiston de Chateauneuf 252 

65. Influence of certain Profes- 
sions in the Production of 
Phthisis Pulmonalis. By Dr. 
Lombard .... 255 



Chemistry. 



66. On the state of Mercury in 
Mercurial Ointment. By M. 
Mitocherlich - 255 

67. On the Existence of Hydro- 
cyanic Acid in Cheese. By Dr. 
Witling ---- 256 



of the Pulmonary 
By M. Collard de 



68. Analysis 
Exhalation. 
Martigny - 

69. Preparation of Salicine. 
M. Peschier ... 

70. Presence of Manganese in the 
Blood. By Professor Wurzer 



By 



Miscellaneous. 



256 



ib. 



ib. 



71. Case in which several Leeches 
were Swallowed. By Dr. 
Schnuhr .... 257 



72. Acoustic Chair. By Mr. Curtis 257 

73. Connexion of Diseases with 
the Rock Formations of a Coun- 
try. By M. de Caumont . ib. 



AMERICAN INTELLIGENCE. 



Medical Statistics of the Moravian 
Society, established at Beth- 
lehem, Penn. By Lewis D. de 
Schweinitz ... 258 

Treatment of Dyspepsia. By J. E. 
Cooke, M. D. - - - ib. 

The Study of Anatomy Legalized 
by the Legislature of Massachu- 

. setts 264 

Constitution of the General Medi- 
cal Society of Ohio - - 265 

Select Medico-Chirurgical Trans- 
actions ... - 267 

Cyclopaedia of Practical Medicine 268 

Oration delivered before the Phi- 
ladelphia Medical Society, Feb. 
19, 1831. By Thomas Harris, 
M. D. .... ib. 

A Charge addressed to the Gradu- 
ates in Medicine of the Univer- 
sity of Pennsylvania, at the pub- 
lic Commencement, held in the 
College Hall, on Thursday, 
March 24, 1831. By Wm. H. 



De Lancey, D. D. Provost of the 
University .... 269 

Coloured Drawing of the Great ' 
Sympathetic Nerve. By J. P. 
Manec, D. M. P. Lecturer on 
Anatomy and Operative Surge- 
ry at Paris. Copied on stone by 
P. Ancora, Teacher of Drawing 
and Painting, Philadelphia. Let- 
ter press translated and correct- 
ed by J. Pancoast, M. D. - ib. 

Broussais's History of Chronic In- 
flammation ... ib, 

Thompson's Lectures on Inflam- 
mation - - - - ib. 

Colles's Surgical Anatomy - ib. 

Manual of Pathology. By L. Mar- 
tinet ib. 

New Books in the Press - ib. 

University of Pennsylvania - ib. 

Medical College of South Carolina ib. 

Medical College of Ohio - ib. 

New Analysis of Swaim's Panacea 270 

Necrology - ib. 

Advertisements - 271 



Am - Jcnirna i of Med 7 - Sck 



]Flo lo Yol.m. 




.-u,;lc;v.-;> S-:. 



Arri^ Journal ofMtcL^Sdi 



T?TL, IK. Vol.m. 




A-dndsrvon.Sc>. 



,1 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



No. XVI.— August, 1831. 25 



COLLABORATORS, 



Jacob Bigelow, M.M). Professor of 
Materia Medica in Harvard Univer- 
sity ; Boston. 

Edward H. Barton, M. D. of St. 
Francisville, Louisiana. 

Walter Channing, M. D. Professor of 
Midwifery and Legal Medicine in 
Harvard University, Boston. 

N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 

John Redman Coxe, M. D. Professor 
of Materia Medica and Pharmacy in 
the University of Pennsylvania. 

William C. Daniell, M. D. of Savan- 
nah, Georgia. 

William P. Dewees, M. D. Adjunct 
Professor of Midwifery in the Univer- 
sity of Pennsylvania. 

S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of S. Carolina. 

C. Drake, M. D. of New York. 

Benjamin W. Dudley, M. D. Profes- 
sor of Anatomy and Surgery in Tran- 
sylvania University. 

Gouverneur Emerson, M. D. of Phila- 
delphia. 

Thomas Fearn, M. D. of Alabama. 

John W. Francis, M. D. Professor 
of Obstetrics and Forensic Medicine 
in Rutgers Medical College, N. York. 

E. Geddings, M. D. Lecturer on Anato- 
my and Surgery, Charleston, South 
Carolina. 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 
vania. 

R. E. Griffith, M.D. Lecturer on Ma- 
teria Medica and Pharmacy in the 
Philadelphia School of Medicine. 

E. Hale, M. D. of Boston. 

Robert Hare, M. D. Professor of Che- 
mistry in the University of Pennsyl- 
vania. 

Isaac Hays, M. D. one of the Surgeons 
of the Pennsylvania Infirmary for 
diseases of the Eye and Ear. 
George Hay ward, M. D. of Boston. 

Thomas Henderson, M. D. Professor 
of the Theory and Practice of Medi- 



cine in the Columbian College, Dis- 
trict of Columbia^ 

William E. Horner, M. D. Adjunct 
Professor of Anatomy in the Univer- 
sity of Pennsylvania. 

David Hosack, M. D. Professor of the 
Institutes and Practice of Medicine in 
Rutgers Medical College, New York. 

Ansel W. Ives, M. D. of New York. 

Samuel Jackson, M. D. Assistant to the 
Professor of the Institutes and Practice 
of Medicine and Clinical Practice in 
the University of Pennsylvania. 

Samuel Jackson, M. D. of Northum- 
berland, Pennsylvania. 

C. B. Matthews, M. D. of Philadel- 
phia. 

Valentine Mott, M. D. Professor of 
Pathological and Operative Surgery 
in the College of Physicians and Sur- 
geons, New York. 

James Moultrie, Jr. M. D. of Charles' 
ton, S. C. 

Reuben D. Mussey, M. D. Professor 
of Anatomy and Surgery in Bart- 
mouth College, New Hampshire. 

James M. Pendleton, M. D. Lecturer 
on Midwifery and Diseases of Women 
and Children, New York. 

Philip Syng Physick, M. D. Profes- 
sor of Anatomy in the University of 
Pennsylvania. 

Nathaniel Potter, M. D. Professor of 
the Theory and Practice of Medicine 
in the University of Maryland. 

D. L. Rogers, M. D. of New York. 
Thomas Sewall, M. D. Professor of 

Anatomy and Physiology in the Co- 
lumbian College, District of Colum- 
bia. 

A. F. Vache, M. D. of New York. 

John Ware, M. D. of Boston. 

John C. Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

J. Webster, M. D. Lecturer on Ana- 
tomy and Surgery, Philadelphia. 

N. W. Worthington, M. D. Professor 
of Materia Medica in the Columbian 
College, District of Columbia. 

Thomas H. Wright, M. D. Physician to 
the Baltimore Aims-House Infirmary. 



TO READERS AND CORRESPONDENTS 



We have received the following 1 works:— 

Cours de Pharmacologic ou traite elementaire d'histoire naturelle medicaie 
et Pharmacie et de Therapeutique suivi de Part de formuler. Par F. Foy, M. P. 
Professeur particulier de Pharmacologic, &c. 8tc. 2 vols. 8vo. G. Bailliere, 
Paris, 1831. (From the Author.) 

Transactions of the Medical and Physical Society of Calcutta, Vols. III. and 
IV. (From the Society.) 

De la distribution par mois des Conceptions et des Naissances de l'Homme, 
consideree dans ses rapports avec les saisons, avec les climats, avec le retour 
periodique annuel des epoques de travail, et de repos, d'abondance et de ra- 
rete des vivres, et avec quelques institutions et coutumes sociales. Par L. R. 
Villerme. (From the Author.) 

Clinical Illustrations of Fever comprising a report of Cases treated at the 
London Fever Hospital, 1828-9. By Alexander Tweedie, M. D. Member of 
the Royal College of Physicians, London, Physician to the Fever Hospital, 
London. Philadelphia, Carey & Lea, 1831. (From the Publishers.) 

Anatomical Demonstrations; or Collossal Illustrations of Human Anatomy. 
By Professor Seerig. Translated from the German. Part I. London, A. Schloss, 
(From the Publisher.) 

Anatomical Atlas on an entirely new plan. By M. J. Weber. Professor ot 
the Royal Prussian University, Frederic William, at Bonn. Sect. 1. London, 
A. Schloss. (From the Publisher.) 

Explanation of the Anatomical Atlas of Dr. M. J. Weber. (From the Pub- 
lisher. ) 

An Analysis of the Mineral Waters of Saratoga and Ballston, with Practical 
Remarks on their Medicinal Properties; together with a history of the disco- 
very and settlement of these celebrated Watering Places, and observations on 
the Geology and Mineralogy of fthe surrounding country. By John H. Steel, 
M. D. Saratoga Springs, 1831. (From the Author.) 

The Pharmacopoeia of the United States. By authority of the National Medi- 
cal Convention, held at Washington, A. D. 1830. (From the Committee of 
Publication.) 

Laws for regulating Medical Societies, together with the By-laws and Medi- 
cal Ethics for the Medical Society of the County of Rensselaer, incorporated in 
1806. With a list of the members. Published by order of the Society. Troy, 
1831. (From the Society.) 

Disputatio Medica Inauguralis de Cynanche Tracheali; auctore Samuel Malins, 
Edinburgh, 1830, (From the Author,) 



284 TO READERS AND CORRESPONDENTS. 

Directions for making- Anatomical Preparations, formed on the basis of Pole, 
Marjolin, and Breschet, and including 1 the new method of Mr. Swan. By Usher 
Parsons, Professor of Anatomy and Surgery. Philadelphia, Carey and Lea, 

1830. (From the Publishers.) 

An Exposition of the Principles of the New Medical Doctrine, with analysis 
of Theses sustained on its different parts. Translated from the French of J. 
M. A. Goupil, D. M. P. &c. &c. By Josiah C. Nott, M. D. To which is 
appended a short essay on leeches, by the Translator. Columbia, S. Carolina, 

1831. (From the Translator.) 

A Treatise on Indigestion; with Observations on some Painful Complaints 
originating in Indigestion, as Tic Douloureux, Nervous Disorder, &c. By Tho- 
mas J. Graham, of the University of Glasgow, and the Royal College of Sur- 
geons, London, &c. First American from the last London edition; revised and 
enlarged, with notes; and an Appendix, containing observations relative to the 
mode of treating Dyspepsia, lately adopted and recommended by Dr. Avery, Mr, 
Halsted, and others. By an American Physician. Philadelphia, Key & Meilke. 
(From the Editor.) 

Importance of Physical Education. A Lecture delivered before the Conven- 
tion of Teachers and other friends of Education, assembled to form the Ameri- 
can Institute of Instruction, August 20th, 1830. By John C. Warren, M. D. 
Professor of Anatomy and Surgery, in the Medical School of Harvard Univer- 
sity. Published at the request of the Board of Censors. (From the Author.) 

The Catechism of Health; or plain and simple rules for the Preservation of 
the Health and Vigour of the Constitution from Infancy to Old Age. (From 
the Publisher.) 

Observations on the Prevention and Cure of Hydrophobia, according to the 
latest popular publications in Germany. Read before the New York Medical 
and Philosophical Society. By Joseph Leo-Wolf, M. D. New York, 1831. 
(From the Author. ) 

An Introductory Lecture on Midwifery, comprising a Critical, Historical, and 
Ethical Disquisition on that branch of Science, delivered February 7th, 1831, 
at the School of Medicine in Liverpool. By Samuel Malins, M. D. Lecturer 
on Midwifery, 8cc. Liverpool, 1831, T. Kaye. (From the Publisher.) 

Transactions Medicales; Journal de Medecine Pratique et de literature Me- 
dicale, February, March, 1831. (In exchange.) 

Annales de la Medecine Physiologique, August, 1829, December, 1830, Ja- 
nuary, 1831. (In exchange.) 

Archives Generates de Medecine, February, March, 1831. (In exchange.) 

Revue Medicale, January, February, March, 1831. (In exchange.) 

Bulletin des Sciences Medicales, October, November, 1831, (In exchange.) 

Journal Universel et Hebdomadaire de Medecine et de Chirurgie Pratiques 
et des Institutions Medicales, March, 1831. (In exchange.) 

Journal de Chimie Medicale, February, 183L (In exchange.) 



TO READERS AND CORRESPONDENTS. 285 

Gazette Medicale de Paris, February, March, April, 1831. (In exchange.) 

Nouvelle Bibliotheque Medicale, June, 1829. (In exchange.) 

London Medical and Physical Journal, February, March, April, May, 1831, 
(In exchange.) 

London Medical Gazette, August, 1830, and January, February, and March, 
1831. (In exchange.) 

The Edinburgh Medical and Surgical Journal, April, 1831. (In exchange.) 

The Medico- Chirurgical Review, April, 1831. (In exchange.) 

London Medical and Surgical Journal, February, March, April, 1831. (In 
exchange.) 

The Glasgow Medical Journal, November, 1830, February, 1831. (In ex- 
change.) 

The Midland Medical and Surgical Reporter, February, 1831. (In exchange. ) 

The Journal of the Royal Institution of Great Britain, February, 1831. (In 
exchange. ) 

North of England Medical and Surgical Journal, November, 1830, and Fe- 
bruary, 1831. (In exchange.) 

Boston Medical and Surgical Journal, Vol. III. Nos. 19 to 22. (In exchange.) 

Transylvania Journal of Medicine and the Associate Sciences, Vol. IV. No. 
1. (In exchange.) 

The Western Journal of the Medical and Physical Sciences, Vol. IV. No 4. 
(In exchange.) 

The Maryland Medical Recorder, Vol. II. Nos. 1 and 2. (In exchange.) 

The New York Medical Journal, May, 1831. (In exchange.) 

The North American Medical and Surgical Journal, July, 1831. (In ex- 
change.) 

For the gratification of our contributors we continue the references to the 
works in which they will find notices of their communications; these references 
are, as usual, restricted to the Journals received during the preceding three 
months. 

Professor Mott will find his case of Ligature of the Subclavian Artery copied 
in the London Medical Gazette, for April, 1831. 

Professor Horner's case of Ozena is noticed in the London Medical Gazette, 
for February, 1831. 

Professor Dickson's case of Amnesia is noticed in the Western Journal of 
the Medical and Physical Sciences, for April, 1831. 

Professor Parsons' paper on the Comparative Influence of Vegetable and 
Animal Decomposition, as a Cause of Fever, will be found republished, with a 
few alterations, in the Maryland Medical Recorder, for July, 1831. 

Professor Wright's paper on the Reunion of Fractures is noticed in Brous- 

25* 



286 TO READERS AND CORRESPONDENTS. 

sais's Annales, for August, 1829 — and his cases of Inflammation of the Brain 
in the Maryland Medical Recorder, July, 1831. 

Dr. Harris's case of Enlarged Tongue is copied in the Archives Gene« 
rales, for February, 1831. 

Dr. Jackson's paper on the Use of Rhubarb in Haemorrhoids, is noticed in 
the Revue Medicale, for February, 1831, and in the Gazette Medicale for the 
same month. 

Dr. Geddings's observations on Strychnine are noticed in the Transylvania 
Journal, No. XIII. and his remarks on the Use of 01. Terebinth, as a cure for Sali- 
vation are copied in the London Medical and Surgical Journal, for April, 1831, 

Dr. Mitchell's New Practice in Rheumatism is noticed in the N. A. Medical 
and Surgical Journal, for July, 1831. 

Dr. Faust's experiments on Endosmose are copied in the Archives Gene- 
rales, for February, 1831. 

Dr. Fahnestock's observations on the Use of Compound Tincture of Ben- 
zoin in Burns are noticed in the Archives Generates, for March. 

Dr. Callaghan's account of the Epidemic Scarlatina of Western Pennsylva- 
nia, is copied in the Boston Medical and Surgical Journal, for May. 

Dr. Roe's case of Poisoning relieved by Emetics per Anum is copied in the 
Boston Medical and Surgical Journal, for June, and in the London Medical 
Gazette, for April. 

Dr. Cart wright's method of Draining the Thorax is noticed in the London 
Medical Gazette, for April. 

Dr. Smart's case of Traumatic Tetanus is noticed in the London Medical 
and Physical Journal, for February. 

Dr. Hort's case of Poisoning with Corrosive Sublimate relieved by Char- 
coal is noticed in the London Medical and Physical Journal, for February. 

Mr. Carpenter's method of consolidating Copaiba is noticed in Froriep's 
Notizen, for October, 1829. 

Authors of new medical books, desirous of having them reviewed or noticed 
in this Journal at the earliest opportunity, are invited to transmit to the Editor 
a copy as soon after publication as convenient, when they will receive prompt 
attention. Under ordinary circumstances, very considerable delay is caused. 
by the circuitous routes through which they are received. 

Papers intended for publication, should be sent, free of expense^ as early after 
the appearance of the Journal as possible, in order to be in time for the en- 
suing number. Such communications should be addressed to " Caret & Lea, 
Philadelphia, for the Editor of the American Journal of the Medical Sciences.*' 
All letters on the business of the Journal to be addressed exclusively to the 
publishers. 



CONTENTS- 



ORIGINAL COMMUNICATIONS, 

ESSAYS. 
Art. . Pass?. 

I. An Essay on the Nature and Sources of the Malaria or Noxious Miasma, 
from which originate the Family of Diseases, usually known by the de- 
nomination of Bilious Diseases; tog-ether with the best means of prevent- 
ing the Formation of Malaria, removing the Sources, and obviating their 
Effects on the Human Constitution, when the Cause cannot be removed. 
By Charles Caldwell, M. D. Professor of the Institutes of Medicine and 
Clinical Practice in Transylvania University. (Published in this Journal 

at the request of the Medical and Chirurgical Faculty of Maryland) - 294 

II. Cases of Pulmonary Consumption, with Observations. By Thomas 
Henderson, M. D. Professor of the Theory and Practice of Medicine in 
the Columbian College, D. C. 340 

III. Account of a Double Female Foetus. By W. E. Horner, M. D. Adjunct 
Professor of Anatomy in the University of Pennsylvania. [With a plate] 349 

IV. Case of a Tumour in the Neck, with an account of the Operation for 
its Removal. By George Hayward, M. D. one of the Surgeons of the 
Massachusetts General Hospital - - - - - - - - 352 

V. Some Account of the Pneumonia Biliosa, as it occurred in Hind 
County, Mississippi, in the Winter and Spring of 1831. By W. F. 
Luckie, M. D. .......... S54 

VI. Case of Bilious Remittent Fever, accompanied by an extensive Irrita- 
tion of the Mucous Membrane of the Mouth. By C. B„ Hamilton, M. D. 

of Washington, D. C. - .... - . . . . 357 

VII. On the Treatment of Haemorrhoids. By William M. Fahnestock, M. D. 359 

VIII. Case of Labour. By Ashbel Woodward, M. D. of Franklin, Con- 
necticut _-------■-_. 370 

IX. Contributions to the Pathology of Infantile Convulsions. By William 
E. Horner, M. D. Adjunct Professor of Anatomy in the University of 
Pennsylvania _--„--..___ 373 

X. Remarks on Scurvy, with a Case. By J. Pancoast, M. D. - - 375 

XI. Case of Diffused Femoral Aneurism, for which the External Iliac Ar- 
tery was Tied. By Valentine Mott, M. D. Professor of Surgery in the 
College of Physicians and Surgeons, New York - - - _ 393 

XII. Post-mortem Examination of a patient who died from the bite of a 
Rattlesnake, (Crotalus horridus.) By W. E. Horner, M. D. Adjunct Pro- 
fessor of Anatomy in the University of Pennsylvania - - - 397 

MEDICAL EDUCATION AND INSTITUTIONS. 

XIII. An Account of the Origin, Progress, and Present State of the Medical 
School of Paris ..----.... 401 



288 CONTENTS. 



REVIEWS. 



XIV. On a Peculiar Form of Haemorrhage from the Uterus. By Robert 
Gooch, M. D. 419 

XV. De LTnfluence de L'Estomac sur la Production de L'Apoplexie, apres 
les Principes de la Nouvelle Doctrine Physiologique, &c. Par J. R. A. 
Richond, Doct. en Med. &c. 8vo. pp. 164. Paris, 1826 - - 436 

XVI. Cours de Pharmacologic; ou Traite Elementaire d'Histoire Naturelle 
Medicale, de Pharmacie et de Therapeutique, suivi d'art de formuler. 
Par F. Foy, M. D. etPharmacien de la Faculte de Paris; Professeur par- 
ticulier de Pharmacologic, &c. 2 toms. 8vo. Paris, 1831 - - 441 

BIBLIOGRAPHICAL NOTICES. 

XVII. Epidemiologia Espanola, o Historia Cronologica de las pestes, Con- 
tagios, Epidemias y Epizootias que han Acaecida en Espana, desde la 
venida de los Cartagineses, hasta el afio 1801. Con noticia de algunas 
otras enfermidades de esta especie que han sufrido los Espanoles en otros 
Reynos, y de los Autores Nacionales que han escrito sobre esta materia, 
asi en la peninsula como fuera da ella. Por el Licenciado Don Joaquin 
de Villalba, Professor de Cirugia Medica, Primer Ayudante de Cirujano 
mayor del exercito, Academia de la Real Academia Medica Matriteuse, 
&c. &c. 2 Tomo, pp. 348. Madrid, 1803 

A Chronological History of the Plagues, Epidemics, Epizootics, &c. which 
have affected the Spaniards from the earliest periods up to 1801. By 
Don Joaquin Villalba, &c. - - - 449 

XVIII. De la distribution par mois des Conceptions et des Naissances de 
PHomme, considered dans ses rapports avec les saisons, avec les climats, 
avec le retour periodique annuel des epoques de travail et de repos, 
d'abondance et de rarete des vivres, et avec quelques institutions et 
coutumes sociales. Par L. R. Villerme. Paris, 1830, pp. 103, 8vo. - 456 

XIX. Dublin Hospital Reports and Communications in Medicine and Sur- 
gery. Volume the Fifth. Dublin, 1830, pp. 631, 8vo. - - 459 

XX. Transactions of the Medical and Physical Society of Calcutta. Vol. 

IV. Calcutta, 1829, pp. 449, 8vo. 471 

XXI. Anatomical Demonstrations; or Colossal Illustrations of Human 
Anatomy. By Professor Seerig. Translated from the German. Part I. 

A. Schloss, London, 1831, pp. 34, 8vo. with four folio plates - 474 

XXII. Anatomical Atlas on an entirely new plan. By Professor M. J. 
Weber, Professor at the Royal Prussian University, Frederick William, 

at Bonn. A. Schloss. London, 1831 ------ ib. 

XXIII. Select Medico-Chirurgical Transactions; a Collection of the most 
valuable Memoirs read to the Medico-Chirurgical Societies of London 
and Edinburgh; the Association of Fellows and Licentiates of the King 
and Queen's College of Physicians in Ireland; the Royal Academy of 
Medicine of Paris; the Royal Societies of London and Edinburgh; the 
Royal Academy of Turin; the Medical and the Anatomical Societies of 
Paris, &c. &c. &c. Edited by Isaac Hays, M. D. Philadelphia, Carey 
and Hart, 1831, pp. 420, 8vo. 47 



CONTENTS, 



289 



QUARTERLY PERISCOPE 

FOREIGN INTELLIGENCE. 

Anatomy. 



Page. 
1. Malformation. By Mr. Houston 477 
2.' Two newly-discovered Muscles 
for compressing' the Dorsal Vein 



Page. 
of the Penis in Man and other 
Animals. By Dr. Houston - 477 
3. Congenital absence of the Gall- 
bladder. By M. Amussat • 478 



Physiology. 



4. Case of Spontaneous Lactation 
at an advanced age. By George 
Semple, Esq. 478 

5. Identity of the Nervous and 
Electric fluids. By Dr. David ib. 



6. Experiments on the actjon of 



certain substances immediately 
applied upon different parts of 
the Brain. By M. Flourens 480 

7. On the Effects of Posture on 
the Frequency and Character of 



the Pulse. By Dr. Graves 



Pathology. 



8. On Union of Fractures. By Mr. 
Syme - - - - 481 

9. Ischuria Renalis. By J. Bird, 
Esq. 484 

10. Effect of Posture in Catarrhal 
Affections. By Dr. Graves - 485 

11. On the Complication of Bron- 
chitis and Continued Fever. By 
Dr. Graves 

12. Poisonous Effects of the Blood 
of a Patient upon Leeches. By 
Dr. Graves - 



ib. 



487 



13. Causes of Death in Membran- 
ous Inflammations. By M. 
Broussais - 

14. Hysteria produced by Prolap- 
sus Uteri. By Dr. Suffert - 

15. Cases of Hemiplegia. By Dr, 
Law - - - - '. " 

16. Case of Tumour in the Brain. 
By Robert Law, M. D. 

17. Case of Constitutional Disease 
arising from a simple Local Irri- 
tation. By Dr. Rynd - 



Materia Medica and Pharmacy. 



18. Atrophy of the Mammae pro- 
duced by Hemlock. By Profes- 
sor D'Outrepont - - 491 

19. Dangerous Effects of Inhaling 
Ipecacuanha. By M. Loerig 492 

20. Medicinal Effect of the Elate- 



rine, the Active Principle of the 
Elaterium. By Mr. Morries 
21. Improved Formula for prepar- 
ing Red Precipitate Ointment. 
By Mr. Thomas Clark 



ib. 



485 



488 



ib. 

489 






492 



49" 



Practice op Medicine. 



22. On the Employment of Atmo- 
spheric Air as a Mean of Diag- 
nosis, Prognosis, and Treatment 
of Deafness occasioned by Chro- 
nic Diseases of the Eustachian 
Tube. By M. Deleau, Jr. - 

23. Cases of Paralysis cured by 
Strychnia. By Dr. A. T. Thom- 
son - 

24. Case of obstinate and exten- 



494 



th, 



sive Psoriasis successfully heal- 
ed. By William West, M. D. 493 

25. On the Energetic Contractions 
of the Heart as a guide in the 
employment of Venesection. By 
Dr. Graves - - - 496 

26. Case of Acute Rheumatic Neu- 
ralgia of the Diaphragm. By 
Dr. Coudret - - - 497 

27. Case of Hsemoptysisj showing- 



290 



CONTENTS. 



Page. 
the Utility of Small Bleedings 
in the Treatment of that Dis- 
ease. By J. Cheyne, Esq. - 498 
28. Case of Peritonitis resembling 
that produced by Perforation of 



Page. 

the Intestines, successfully treat- 
ed. By Drs. Graves and Stokes 499 
29. Scrofula treated by com- 
pression. By Mr. Dermott 500 



Ophthalmology. 



30. Cauterization of the Transpa- 
rent Cornea. By M. Serres 500 

31. Case of Fungus of the globe 
of the Eye successfully extir- 
pated. By W. Twining, Esq. 502 

32. On Absorption of the Iris. By 
Mr. Middlemore - - 503 

33. Case of Congenital Malforma- 
tion of the Cornea and Sclero- 
tica. By Mr. Middlemore - ib. 



34. New Operation for the cure of 
Ptosis. By R. T. Hunt, Esq. 503 

35. The Eye Institution of Man- 
chester .... 504 

36. Case of Amaurosis caused by 
the Spontaneous Suppression of 
Scald Head, successfully treated. 

By Dr. Weber - - - ib. 



Surgery. 



37. Case of Fungus Haematodes 
of the Thigh, cured by Ampu- 
tation. By William M 'Do wall, 
Esq. 505 

38. Cases of Idiopathic Glossitis. 

By John Orgill, Esq. - - 506 

39. On Permanent Involuntary 
Contraction of the Muscles. By 
Samuel Smith, Esq. - - 508 

40. Lithotrity in Asia. By Dr. 
Civiale - - - - 509 

41. On the Cure of Strangulated 
Hernia by the Taxis. By George 
M'Leod - ib. 

42. On the Acupuncturation of 
Arteries in the Treatment of 
Aneurism. By M. Velpeau - 510 

43. Tracheotomy. By John Brown, 

M. D. - - - - 512 



44. Case of Pulmonary Abscess 
caused by the lodgment of a 
Chicken Bone in one of the 
Bronchia. By P. Gilroy, M. D. 512 

45. Cases of Wounds of the 
Throat. By Baron Larrey 513 

46. Case of Dislocation of the 
Sacro-iliac Symphysis. By T. 

E, Baker, Esq. - - - 515 

47. On Perforation of the Mem- 
brana Tympani. By Dr. Solera. 516 

48. Case of Fracture of the body 

of the Scapula. By J. Syme, Esq. 517 

49. Cases of Fracture of the Edge 
of the Acetabulum. By Dr. 
M'Tyer .... ib. 

50. Case of Fracture of the Neck 
of the Femur terminating in 
Suppuration. By Dr. M'Tyer 519 



Midwifery. 



51. Follicular Origin of some Va- 
ginal Tumours. By Mr. Heming 520 

52. Case of Pregnancy. By Dr. 
Elliotson .... ib. 

53. Cases of Premature Births. 

By Mr. J. Greening - - 522 



54. Case of Abdominal Foetation. 
— Gastrotomy successfully per- 
formed by Gais of Wiesbaden. 
By Dr. Nagele - - 522 



Medical Jurisprudence. 



55. Are there certain Questions 
which a Medical Man in a Court 

of Justice may refuse to Answer? 523 

56. Can a woman, duringthe whole 



course of Utero-gestation, be ig- 
norant that she is Pregnant? 524 
57. Singular Trial for Infanticide 525 



CONTENTS. 



291 



Medical Statistics. 



Page. 

58. Medical Statistics of the Royal 
Maternity Charity - - 528 

59. On the Effects of Manufac- 



Page. 
tures upon Health and Longe- 
vity. By C. Turner Thackarah, 
Esq. 530 



Chemistry. 



60. Mode of obtaining the active 
principle of the Elaterium. By 
John D. Morries, Esq. - 531 

61. Process for Economically pre- 
paring the Muriate of Morphia. 

By Dr. William Gregory - ib. 



62. Analysis of Secale Cornutum. 

By Mr. R. Battley - - 532 

63. Existence of Copper in Vege- 
tables and Blood. By M. Sarzeau 534 

64. Composition of Kermes Mineral ib, 

65. Salicine from the Athenian 
Poplar. By M. Braconnot - ib, 



66. Paracentesis Cranii. 
Conquest - 



Miscellaneous. 

By Dr. | 67. Epidemic Cholera 

535 



535 



AMERICAN INTELLIGENCE. 



On the Health of that strip of land 
south of Philadelphia called the 
"Neck." By Isaac Hays, M. D. 536 

Case of Anomalous Tumour in the 
Epigastric Region. By Charles 
Hall, M. D. of St. Albans, Ver- 
mont .... - ib. 

Case of Injury of the Skull. By 
William Rankin, M. D. of Ship- 
pensburg, Penn. - - 538 

Case of Poison by Rattlesnake. By 
Dr. Hiram B. Philips, of Bun- 
combe County, North Carolina 540 

Annual Bill of Mortality for 
Charleston, S. C. from the 1st 
of January, 1830, to the 1st of 
January, 1831 - - - 541 

Meteorological Journal kept by 
Henry West, Esq. near the cen- 
tre of Alabama, for 1830 and the 
three first months of 1831 - 545 

Barrenness succeeding the Use of 
Iodine. By Dr. Robert H. Ri- 
vers, of Hardeman Cy. Tenn. 546 

Extirpation of the entire Parotid 
Gland. By Dr. Mott, of New 
York - - - - ib. 

Case of Immobility of the Lower 
Jaw. By Dr. Mott - - ib. 

Action of the Mind on the Body. 
By Professor J. C. Warren ib. 

Alkaline Extract of Jalap. By E. 
Durand - 547 



The Use of Sulphate of Morphine 
in Ophthalmia. By Charles A. 
Lee 

Peculiar Affection of the Organs 
of Taste. By Dr. Chandler Rob- 
bins 

Case of Croup. By Dr. S. D. 
Townsend 

Ischuria. By Dr. L. Depeyre 

Carpenter's Oil of Cantharidin 

University of Maryland 

Dispensatory of the United States 

Journal of the Philadelphia College 
of Pharmacy 

Clinical Illustrations of Fever, com- 
prising a Report of the Cases 
Treated at the London Fever 
Hospital, 1828-29. By Alex- 
ander Tweedie, M. D. 

Medical and Chirurgical Faculty 
of Maryland - - 

Observations on the Prevention 
and Cure of Hydrophobia, ac- 
cording to the latest Popular 
Publications in Germany. Read 
before the New York Medical 
and Philosophical Society. By 
Joseph Leo-Wolf, M. D. - 

Neagle's Gallery of Portraits of 
Medical Men ... 

Index - - - - - 

Advertisements 



547 



ib. 

548 
ib. 

549 
ib. 
ib, 

ib. 



ib. 



550 

ib. 
551 

557 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



Art. I. Reports of Cases treated in the Baltimore Alms-house In- 
firmary. By Thomas H. Wright, M. D. Physician to the Insti- 
tution. 

ENCEPHALIC PATHOLOGY.— It is familiar to the profession, 
that active inflammation of the pulmonary mucous and submucous 
textures, is often associated with signs of congestion about the brain 
and its coverings, which adds much to the sufferings of the patient, 
and occasionally gives rise to cephalic complication of a very serious 
character. Such complication is imported by intense pain, great ful- 
ness, weight, &c. in the head, extra sensibility to light and sound, and 
sometimes oppression of the functions of the sensorium, approximat- 
ing lethargy or stupor. Acute pneumonic catarrh, especially if pro- 
found or protracted, not unfrequently involves a liability to have the 
high irritation of the vascular system by which it is characterized, 
devolved on the brain or its membranes, with so long continuance 
or such great concentration, as very much to embarrass or finally to 
impair. the encephalic organism. Unbalanced movement of circulation, 
deep engorgements, and ultimate effusion within the head, are conse- 
quences that may be apprehended, when severe inflammatory action 
abides in the mucous or serous tissues of the chest, and more parti- 
cularly when super-excitement lingers long in the over-irritable con- 
stitutions of childhood, or in the sluggish systems of age, where the 
capillary, exhalent, and excretory series have lost in part the attri- 
bute of vigorous contractility, and are on that account the more rea- 
dily embarrassed by congestions or overwhelmed in effusion. 
No. XV.— May, 1831. 3 



18 Wright's Baltimore Alms-house Reports. 

The extent, however, no less than the frequency of participation 
by the brain and its membranes, in the inflammatory diathesis, light- 
ed up by catarrh and pneumonitis, were unsuspected by myself, un- 
til revealed in the strongest manner, by a number of cases occurring 
nearly together, part of which cases it is the design of this report to 
describe. The circumstance of their happening in close succession 
rendered them more attractive of notice, while the pathological rela- 
tions disclosed by the cases themselves, appear to invest them with 
a character both interesting and important. They seem to establish 
that inflammatory action set up in the thoracic tissues, and running 
on to a point of great exaltation, or prolonged in an active subacute 
form, is liable to propagate irritation by consent, (metastatic, if al- 
lowable,) on some part of the encephalon, much more profound and 
pathological than is represented by the common pain or other 
distress of head, symptomatic of ordinary febrile development. 
Even in the chronic form, pneumonic catarrh appears capable of 
maintaining a state of constitutional excitability, with peculiar 
tendency to sudden and serious inflammatory congestions within the 
head, not foretold by any sensible or palpable signs of suffering or 
danger in that seat.* The brief relation of a few cases will best ex- 
plain the meaning of those remarks, and show the manner and kind 
of cerebral derangements supposed to arise in a secondary way, or to 
owe their occurrence to a predisposition, (congestive diathesis, or vi- 
tal erection in excess, of Broussais,) in the vascular tissue of the 
membranes of the encephalon, created by the high or long febrile 
perturbation of catarrh, pneumonia, &c. 

Case I. — Secondary Meningitis.-— George Gainer, aged thirty? 
middle size, person fleshy and fat, admitted into the Baltimore Alms- 
house, December 1st, 1829. This patient had febrile catarrh of me- 
dium severity, associated with symptomatic ague. He had cough of 
the rough, hoarse kind, representing tracheo-bronchial congestion, 
with deficient excretion; cough frequent, dry, and ringing, (laryn- 
geal,) no expectoration. There was no pain or sense of soreness 
about the larynx or trachea, and nothing of pulmonary or pleuritic 
pain; breathing was easy, somewhat accelerated, with small wheezing; 

* It is not intended to represent secondary cerebral phenomena, (irritation, 
congestion, and effusion,) as derived solely from primary phlogosis of the 
pneumonic textures. Phlegmasia, or per-acute irritation of the mucous and se- 
rous tissues of other seats, the stomach, bowels, and peritoneum especially, 
may be radiating points, whence symptomatic brain developments arise sud- 
denly or gradually. 



Wrights Baltimore Alms-house Reports. 19 

cough not influenced, nor provoked or aggravated by deep inspira- 
tion; thorax rising up well by voluntary expansion; temperature of 
the body natural, pulse soft, free and quick, ninety-eight; face pale, 
full, as from some bloating; mind clear; manner sprightly; both 
hypochondria rather full without hardness, and somewhat sore, 
supposed from the shock or jar of long-continued hard cough. No 
other derangements any where. Appetite good, tongue clean, evacu- 
ations regular, sleep natural, except interruption by cough. No pain 
of head. The daily form of complicate ague and the troublesome 
cough were all that the patient regarded. These had now lasted 
about twenty days, and were at first brought on by much exposure to 
inclement weather. 

Treatment. — Emesis; afterwards antimonials, nitre, and calomel, 
in diaphoretic doses; epispastics about the thorax. Diet farinaceous; 
drink, diluents, barley water, with weak charge of tart. ant. 1 gr. to 
§xvj. use, ad libitum; absolute rest. By the fifth day ague pa- 
roxysms were lost, cough remained as before, frequent and hard, 
"racking," so called; no expectoration; pulse 100, soft and equal; 
breathing quicker than natural, but easy and deep at will; some 
wheezing; breast and head free from pain; patient cheerful; appetite 
keen; strength improved; no mercurial impression. Antimonials with 
calomel, were continued; mucilage gumarab., syrup, scillas, vin. ipe- 
cac, tinct. digital, directed as expectorant. 

With some modification, (the occasional exhibition of ipecacuanha or 
zinc to the extent of moderate emesis, and re'application of vesica- 
tories about the thorax,) the treatment as reported was continued to 
the fifteenth day from admission. Up to this time the patient was 
considered improving, though slowly; he had become impatient of 
confinement to bed and farinaceous diet, and thought himself now 
scarcely unwell; but as cough continued, breathing still frequent, 
and pulse too quick — rest and restriction of diet were maintained; 
medicines, except palliatives of cough, (brown mixture,) omitted. 

On the 20th of December, nineteenth day in the ward, this man 
was found with febrile symptoms of a higher tone than at any time 
before. Pulse full and sharp, as well as quick, (110,) skin hotter 
than common, head dull aching, face for the first time since admis- 
sion with some red flush, countenance cheerless, mind inert, manner 
drowsy. Cough was lessened, had scarcely coughed for many hours, 
breathing much slower than formerly. Ordered, venesection to §xvj. 
or till acknowledged by the pulse; solution sulph. magnesia, c. tart. 
antimonii, divided doses, to purging. The student in charge was 



20 Wright's Baltimore Alms-house Reports. 

called to the patient in the night, and found him in a state of insen- 
sibility, succeeding a short but violent paroxysm of convulsions with 
delirium, in which much force was necessary to retain him in bed. 
The unconsciousness which had ensued was not that of deep, silent 
stupor or coma, but consisted in abolition of sense, associated with 
constant moaning and rapid incoherent muttering. There was also 
retraction and rolling of the head, with forcible, spasmodic jerking, 
in the muscles of the neck and shoulders. The involuntary and un- 
conscious expression of pain and suffering were attended by incessant 
and forcible spitting, (or rather puffing from the mouth with great 
violence,) a white frothy sputum which appeared in great quantity 
about the patient and his bed. The eyes were rolled under the 
arch of the socket, face bloated and flushed. Bleeding from the arm 
was repeated, and the head cupped freely at numerous points. Deep 
stupor succeeded in a few hours to the movements of agitation, and 
death took place early on the following morning. 

Dissection revealed per-acute meningitis over a large space of the 
pk mater of both hemispheres. Either surface of the vertex portion 
of the membrane was loaded by injection, resembling a fine web of 
tubes gorged by blood and gelatine. Pus was spread in such palpa- 
ble quantity between the arachnoid and pia mater, that it could be 
freely collected by passing the edge or back of the scalpel with a 
light scraping movement over the surfaces. The septa of the con- 
volutions were injected and infiltrated. Pia mater of the lobular 
surface extra fine red arborescence. Medullary pulp as low as 
the great commissure, pink tinge, numerous red points, marking 
section of the nutrient vessels of the pulp. Small serosity of the la- 
teral ventricles. No denatural state, engorgements, or super-co- 
louring, about the membranes of the cerebellum, pons, or medulla 
oblongata. 

Remarks. — The cerebral developments supervening to pure ca- 
tarrh in this case were revealed abruptly, and without any known 
cause. The patient had not left his bed, nor suffered exposure in any 
way — there was no error of diet, or change from the spare, light re- 
gimen on which he had been kept, nor had there been at the time 
any sensible vicissitude of weather, likely to elevate the tonic forces 
of the constitution suddenly, to the pitch of new inflammatory reve- 
lations. From the first signs of disorder about the head, (by heavi- 
ness, dull pain, &c.) to the catastrophe of the case, the whole inter- 
val did not exceed thirty-six hours, yet in that short period inflam- 
mation of part of the brain tunics had reached the maximum of in- 



Wrights Baltimore Alms-house Reports. 21 

tensity of which the sero-fibrous membranes are susceptible, short of 
disorganization, and exhibited in its result the unusual phenomenon 
of profuse suppurative meningitis. 

Case II. — Meningitis. — J. Mount, aged twenty-seven, fair com- 
plexion, dark hair and eyes, above middle size, form muscular, ad- 
mitted into the Baltimore Alms-house, November 17th, 1829. Dis- 
ease chronic remittent fever, complicated with pneumonic catarrh. 
Patient had ague two months before, (in September,) recovered in a 
few days, went to work, was exposed to wet, had return of fever, 
with slight chills, accompanied by dull pain of right and left side, 
cough, soreness of the breast, and soon after tightness of the abdo- 
men with swelling of the lower limbs. Cough was hard and frequent, 
with expectoration of thin phlegm, breathing quick and short, with- 
out acute pain in the breast; very sensible impediment to expansion 
of the chest. 

Symptoms when admitted. — Face pale and bloated; countenance 
dull, (look anxious;) no pain of head; respiration small and fast, no 
wheezing; cough short and sharp, not very frequent; scant expec- 
toration of thin mucus; no pain, and no longer any soreness in the 
breast; power of inspiration less than natural; expiration abrupt. 
Abdomen round and tight; right and left hypochondrium tender; ex- 
tra volume and hardness in both as of hepatic and splenic enlarge- 
ment with condensation; palpable definition and hypertrophy of 
spleen; evolution of liver not plainly discriminated. Pressure on hy- 
pochondria embarrassed respiration and speech. Some ventral dropsy 
and hard oedema of the lower extremities. Fever continued, form 
partially remittent; chills of accession, more properly exasperation, 
not regular, sometimes distinct, often imperceptible; paroxysms pro- 
longed and intermingled, small abatement once in twenty-four hours; 
never complete solution; no perspiration. Pulse quick, with some jar 
of tension; rate of stroke varying from 110 to 125; temperature of 
surface constantly above par of health. Diagnosis. Pneumonic catarrh 
complicated with symptomatic chills, induced by cold co-operating 
with season causes, on the constitutional diathesis of recent inter- 
mittent. Special pathology; chronic inflammation with effusion of 
lymph and gelatine among the thoracic textures, cellular membrane 
of the pleurae and mediastinum; solidification of liver and spleen; 
ventral and superficial cellular dropsy. 

Treatment. — Venesection; cupping hypochondria and inferior tho- 
rax; emetism; purging; vesication around the chest; antimonio-mer- 
curial diaphoretics; diluents; absolute diet; total recumbency. Ge- 



22 Wright's Baltimore Jilms-house Reports, 

neral bleeding, about twelve ounces, was practised four times; cups 
renewed around the chest and hypochondria to the number of fifteen, 
(five and six together,) at intervals of a few days; afterwards epispas- 
tics, successive applications. Calomel, nitre, and antimony, or calo- 
mel, ipecac, squill, and digitalis, were given continuously until ptya- 
lism was revealed, and that state restored to a moderate amount a 
second, and even a third time, with an interval of extinction between 
each impression. Diet was strictly regulated, and quiet in bed uni- 
formly maintained. 

This active plan of treatment steadily pursued for a long time, ac- 
complished the design of its institution only in part, and by tardy 
triumph over some of the complications of the case. The symptoma- 
tic chill was lost and renewed many times at irregular intervals, of 
a few days to a week, and finally ceased altogether. Abdominal and 
cellular infiltrations receded early in the treatment, and remained 
absent. It was in condensation of the liver and spleen, and the de- 
natural state of the forces of circulation and breathing, that the most 
persisting impediments to convalescence were always encountered. 
Those viscera were palpably solidified, long after they ceased to be 
sore to pressure. The pulse of the patient kept steadily over a hun- 
dred, stroke sharp and irritable; heat of surface fever standard. Re- 
spiration all the time betrayed unnatural quickness with restriction, 
especially about the base of the thorax, as if from inaction, disability, 
or fixed obstruction, (by pseudo connexions,) in the moving powers 
and textures, the muscles and membranes of the abdominal margin 
of the chest. In this state of the case apparently unsusceptible of fur- 
ther melioration by depletion, general or local, or by the free excre- 
tions, now long maintained from all the surfaces, it was decided to 
turn the treatment mainly on the resort to that dissolving controul 
often exercised over old congestive impairment, with interstitial 
condensation, by the' relaxing influence and constitutional shock of 
full vomitings. 

The worst and last embarrassments of the case gave way to the 
impression of liberal doses of ipecacuanha and zinc once or twice re- 
peated. The pulse fell to near the par of natural excitement immedi- 
ately on the second repetition of free vomiting, losing its irritative 
frequency, and becoming soft and regular, at the standard of eighty. 
Respiration was liberated at the same time, in an equal degree, 
and after very sensible constraint for two months before, the patient 
now breathed with the slow regularity of the healthy order of that 
function. The case seemed at last every way convalescent, all ten- 
derness of the liver and spleen were extinguished, the latter only be- 



Wright's Baltimore Alms-house Reports. 23 

traying to deep pressure some remains of induration 5 cough was en- 
tirely lost, chest fully expansible and sounded well to percussion in 
every region, countenance easy and natural. The case came under 
care in the middle of November, and was constantly the subject of 
the antiphlogistic and alterative regimen, until the 1st of February 
ensuing, when all the palpable embarrassments having ceased, treat- 
ment was intermitted. Patient remained in hospital: diet more li- 
beral but not gross. 

On the 15th of February this man came again under notice. He 
was in bed, complaining of being very unwell. Symptoms at this 
time — obscure chills; heat and feeling of fulness; sense of numbness, 
all over the body; heaviness and oppression of the head without posi- 
tive pain; mind dejected; face with some red flush; no pain of the 
breast, cough, or difficulty of breathing; pulse ninety, full and jar- 
ring. Ordered, venesection, (sitting up,) till depletion was felt; 
cups on temples and forehead; calomel, nitre, and jalap, each ten 
grs:; regimen bread water. Next day, 16th, countenance more anxi- 
ous; face sallow; head heavy and disposed to ache; eyes injected; 
cellular tissue of sclerotica fine rose tint, pupils dilated; tongue fur- 
red, some tremulous movement when put out; breathing slow and 
heavy; no cough or pain of the breast. Patient complained of stiff- 
ness in the arms and hands, which he attributed to the bleeding; 
both arms benumbed from the shoulder to the fingers; pulse 110, con- 
tracted and hard. Blood drawn yesterday, solid coagulum, border 
inverted, yellow-white sheet of fibrin on surface of coagulum. The 
symptoms announced arachno-spinitis of the second grade. Repeat 
venesect, p. r. n. ; cups behind the ears and over occipitocervical 
space; parietal planes shaved; wet, (cold,) envelope for the head con- 
stantly renewed; tart, ant., nit. potass., g. acacise, repet. tert. horis; 
stimulating enemata. 

17th, Pulse quick, small, and fading under pressure; skin hot and 
moist; partial stupor, but conscious when roused; acknowledged 
head-ache; articulation imperfect; eyes red suffusion; pupils wide; 
face more sallow; tongue dry; tremor of tongue and head. Slight 
spasmodic movements of the trunk and thorax; arms drawn to sides 
and motionless; frequent efforts to move the body without the power 
to change place; breathing hurried and irregular with moaning. Or- 
dered epispastics to parietals and legs, camphor julep with ammo- 
nia, mercurial friction freely on abdomen and thighs, bowels to be 
moved by enema, cordial fluid nutriment. 

ISth. All symptoms aggravated; stupor complete; eyes closed, 
(lid fallen,) pupils contracted; patient sunk down in bed; skin cold 



24 Wright's Baltimore Alms-house Reports. 

and moist; pulse thready; breathing small and slow. Death occurred 
on the 20th. 

Dissection ten hours after death. — Cranial aspect of dura mater na- 
tural every where, except over posterior lobes of cerebrum; adhesion 
to the cranium at the point indicated stronger than elsewhere; mem- 
brane in this part injected and blood-stained for some inches. Dura 
mater cut up and reflected to expose posterior cerebral lobes, showed 
high florid patching of its inner face generally — deepest and with 
gelatinous exudation, where it covers posterior lobes. Arachnoid tu- 
nic super-coloured, and spread with semi-concrete lymph over its 
whole vertex portion; posterior surface of same membrane coated for 
some extent by pus in considerable quantity. The superficial vascu- 
lar plexus of the cerebellum, pons, and medulla oblongata, highly in- 
jected and infiltrated. Lymph effused in mass around corpus py- 
ramidale. Medullary pulp of a pink tinge generally; softening, 
with appearance of pus, in part of posterior lobes of cerebrum. Small 
serosity in lateral ventricles. * 

This was a second case of diffuse meningitis, apparently develop- 
ed from constitutional irritation, kept up by chronic inflammatory 
catarrh. The primary super-excitement had resulted in lesion of part 
of the fibrous organism of the chest and abdomen, by interstitial de- 
posit, with condensation of texture. At the same time, long tumult 
of the vascular function would seem also to have left the capillary 
system in a state of weakness and irritability, prepared for sudden 
congestive derangements, on the new application of any causes dis- 
turbing the balance of forces in that system. Why the terminal se- 
ries of the membranes of the encephalon; should partake the liability 
supposed, in a special degree, is not readily intelligible. The facts in 
the present and similar instances point to the conclusion alleged, but 
leave the manner and the reason unexplained. Particular inquiries 
were made at the time of attack, in the case just reported, but no- 
thing could be learned respecting the probable exciting agency. 

Case III. — Secondary Cerebritis. — William Dunihan, aged about 
forty, middle size, person lean, sanguine temperament, sandy hair, 
light eyes, fair complexion, received into the Baltimore Alms-house, 
January 27th, 1830. On the 28th I found this patient in ward with 
the following symptoms. Fever high; pulse 110, full, round, and 
jarring; skin hot. Face flushed in patches; colour pale rose red, 
with slight tinge of yellow; eyes faint bilious hue; countenance 
distressed; head painful. Breathing quick and laboured, with 
audible blowing, or bellows-like, (soufflet,) sound of respiration. 



Wright's Baltimore JUms-house Reports. 25 

Cough frequent, low, and hissing, as if extinguished or lost in the 
bronchi and trachea; voice flat; harsh aspiration, (husky;) expectora- 
tion of thin reddish-yellow sputum; no distinct pain in the breast. 
Abdomen generally large and tense; right hypochondrium promi- 
nent and super-sensitive; instant shrinking from moderate pressure 
over hepatic space. There was preternatural tenderness to the touch 
on the right thorax as high as the sixth rib; no sudden hurt or check 
in making full inspiration. Diagnosis. Inflammation of parenchyma 
of right lung and liver. 

The student in charge had bled the patient freely on the evening be- 
fore, (27th,) and had exhibited calomel and pulv. antimonialis to 
full purging. Ordered to-day, (28th,) venesection, (patient sitting,) 
till acknowledged by feeling and pulse; cups to right thorax and hy- 
pochondrium; calomel, gr. ij.; pulv. antimonialis, gr. iv. ; nit. potass* 
gr. vj. tertiis horis; neutral solution, gviij.; tart, antimon. gr. ij.; 
§ss. in aq. hord. every hour until nausea or diaphoresis. Diet and 
drink, gruel and rice water. 

29th. Symptoms meliorated; countenance less anxious; slight flush 
of cheeks; breathing less bellows-like, and slower; voice still rough 
and soundless, (tracheal,) sense of weight in the chest, without 
pain or stitch in drawing the breath; cough frequent, softer and less 
restrained; free expectoration of pale, bloody, and frothy mucus. 
Temperature of surface reduced; pulse 110, full and well developed, 
but less jar of stroke than on the 28th. Right hypochondrium flatter 
and less sore to pressure. Blood drawn yesterday buffy in excess,* 
Prescription — repeat general bleeding to eight or ten ounces; cups 
on thorax close as convenient to the former; epispastic on right hy- 
pochondrium; calomel and nitrous powders with antimonial solution 
continued. Diet and drink as before. 

30th. All symptoms better; countenance placid; breathing slower 
and scarcely audible; voice articulate; cough less frequent; expecto- 
ration easy; skin soluble; heat temperate; pulse ninety and soft; no 
pain in the breast; breathing free; abdomen natural volume. Blister 
raised well; blood last drawn, cupped, with small buff. 

From 31st of January to 9th of February, amendment was steady? 
fever always mild grade after 30th of January, faded away altogether 
by 4th of February; cough and expectoration were gradually declin- 

* The sheet of fibro-gelatin concrete on the blood, (drawn 28th,) was rea- 
dily separated, being- spontaneously almost detached from the erassamentunx 
Put into alcohol, it became a beautiful white cake, perfectly circular, five inches 
diameter, soft silky surface both sides, five-eighths of an inch thick, heavy* 
elastic, and so tough that it could be neither cut or torn but by much force* 



26 Wright's Baltimore Jllms-house Reports. 

Ing, the latter losing all tinge of blood; breathing soft and equal 5 
skin temperate; pulse about eighty; no pain any where; slight tender- 
ness of liver to deep pressure. — Rest in bed, regulated diet, soluble 
bowels, with light mercurial friction on right hypochondrium, con- 
stituted the total regimen from 4th to 8th of February. 

On the 9th of February the aspect of this case was wholly chang- 
ed. At our visit this morning the patient was found in a state of in- 
sensibility, position supine, arms thrown down and pressed close to 
sides, head drawn back, mouth wide, upper eyelids very much rais- 
ed, eyes retroverted, pupils under arch of the orbit, eyeballs in ra- 
pid tremulous movement; face cadaverous. Breathing was high, 
quick, and hard, loud bronchial rattle, with muttered moanings; skin 
hot; pulse 112, large, round, and jerking. The change described had 
occurred in the night past — in the morning the man was unconscious, 
and nothing could be learned of the circumstances or manner of at- 
tack. The patient was cheerful the evening before, eat his light sup- 
per as usual, and had not complained of head-ache or any thing else. 
The weather was cold, but without any remarkable variation at the 
time, and the patient's place and accommodations in hospital were 
sheltered and comfortable. 

Within a few hours the circumstances of this case exhibited a 
striking contrast. On the 8th it presented all the signs of convales- 
cence which are common attendants on the solution of inflammatory 
fever, viz. general relaxation, temperate skin, pulse small, soft, and 
equal. The following day these were substituted by the phenomena 
above described, all representing a grade of excitement alike intense 
and universal. It was scarcely credible, that to a crisis so marked 
by debility and languor of all the functions, should supervene in a 
moment, a constitutional display of so exalted reactive struggle. Per- 
acute cerebritis was the unequivocal character of this new explosion. 
Prescription — venesection; scalp shaved and cups applied freely 
over the head, succeeded by cold steadily renewed; venesection 
repeated if pulse was not softened by first bleeding and cupping; 
lower extremities immersed in hot water; stimulating enema. On the 
9th deep coma, head still retracted, eyes fixed introversion, cornea 
invisible, pulse small and rapid, surface cold, breathing quick, short 
and rattling, with abrupt spasmodic interruption. Patient died in the 
night of 10th. 

Dissection twelve hours after death. — Dura mater very bloody, by 
discharge from rupture of small vessels in tearing up cranium; 
membrane itself thorough red, from capillary engorgements. Arach- 
noid, small serosity on surface; pia mater, extreme red aborescence. 



Wright 3 s Baltimore Alms-house Reports. 21 

Cerebrum; gray and white pulp softened, the latter reddish. In 
many points exposed by slicing cerebral substance, deposits of pus, 
appeared so distinctly, and in such quantity, as to render its nature 
unquestionable. Some of this purulent formation was apparent in 
nearly the whole superior and central parts of the front, middle, and 
posterior lobes of the cerebrum. The substance of the cerebellum 
was firm, and showed no extra natural appearance. 

The lungs of this subject were carefully examined. Left lung na- 
tural. The central portion of middle lobe of right lung showed dis- 
tinctly the fading marks of the red condensation, so well described 
by Andral. The colour of the part was higher than natural, paren- 
chyma more compact and firmer than the rest of the lung — surface of 
the solidified part showing patches of effused lymph. Compacted sub- 
stance insensibly lost in the surrounding crepitous texture of the 
lung — similar marks of recent congestion, presented on superior con- 
vex surface of the liver. 

Suppurative cerebritis was the essential pathology revealed by dis- 
section; and is the more remarkable, from the infrequency of the le- 
sion so rapidly accomplished in this instance. Even inflammation 
of the more common grade, is comparatively a rare affection of the 
medullary pulp. The apparent inaptitude of the substance of the 
brain and nerves to take on inflammation, is noticed by Bichat and 
others. 

Case IV. — Cerebral Congestion — Remittent or Jilt ernaiing form, 
— J. Cavanaugh, aged forty-two, sallow complexion, black hair and 
eyes, admitted into the Baltimore Alms-house, January 12th, 1830:, 
Disease irregular intermittent, with secondary pneumonic catarrh* 
Paroxysms of chill and fever, varying type, had lasted four weeks 
prior to admission; pneumonic catarrh supervened in the last two 
weeks. Patient had cough, sharp, harsh sound, no expectoration , 
breathing small, quick, confined; limited expansion of chest, no pain 
in the breast. Pulse in general small, soft, and frequent— palpable 
condensation of liver and spleen — some hydrops ventralis — slight 
anasarca of lower extremities. 

Treatment. — Local; cups to thorax, right and left hypochondriunK 
epispastics. Constitutional; mercurial alterative course, calomel, 
squill, and ipecacuanha — with aperients pro re nata. Cupping was re- 
peated as seemed indicated, and the alterative plan — with occasional 
modification of agents- — continued five weeks. The case improved 
slowly under the course, but convalescence was incomplete. With- 
out sensible mercurial impression, the signs of chronic enlarge- 



28 Wright's Baltimore Alms-house Reports. 

ment, solidification, &c. of liver and spleen, and all infiltra- 
tions disappeared. There was left, however, cough, quickness and 
constraint of breathing, with irregular fits of symptomatic ague; 
pulse more frequent than natural. The nature of the remaining em- 
barrassments, (chronic congestion, and lymphatism of part of the se- 
rous textures,) with the success of the same resort in former similar 
instances, led to the employment of a few active emetics, in the pre- 
sent state of the case. The result was entirely satisfactory. Restric- 
tion of breathing was taken off, cough ceased, and constitutional irri- 
tation was quieted; and the pulse ranged about the par of health. 
Convalescence seemed now founded on salutary reaction in all the 
functions. 

The case was discharged from medical regimen in the middle of 
February, and called for no further notice for an interval of eighteen 
days; the patient's appearance, feeling, &c. implying no need of 
more than rest and time. On the 3d of March, Cavanaugh again 
complained of feeling unwell. He spoke now of confusion, lightness, 
amounting to vertigo, and some pain in the head, with dullness, and 
depression of spirits, symptoms which were first felt the day before, 
and had increased. 

The pulse betrayed only slight febrile movement, and the bowels 
being slow, a purgative was ordered, with abstinence from all exer- 
tion. In the night of the same day, the man fell suddenly into a 
state of unconsciousness, soon followed by universal, violent, and 
constantly renewed convulsions. The student formerly in charge of 
the patient, came to him in a few minutes from the attack, and dis- 
criminating the analogy of the present, to previous cases of brain in- 
vasion, supervening to prolonged pneumonic catarrh, very judiciously 
acted on the indication which the character of lesion in those cases 
furnished; notwithstanding much general debility of the patient con- 
sequent to recent illness, he was now bled with great freedom; the 
amount of blood taken, estimated about twenty-two ounces. The 
bleeding was followed by subsidence of convulsions, and restoration 
of consciousness in the course of an hour, patient still complaining 
of confusion of head, with some pain. Towards night, disorder of 
head increased, and symptoms of threatened convulsions re-appearing, 
venesection was repeated, about sixteen ounces, and an active ca- 
thartic administered. Next day, "patient very weak, head easy, pulse 
small and soft, pupil of right eye much dilated. For many succeed- 
ing days there was alternate absence and renewal of fits of vertigo, 
and pain of head; pupil of right and left eye becoming in turn pre- 
ternatu rally large. By strict rest, moderate purging, and light diet, 



Wright's Baltimore Alms-house Reports. 29 

these signs of cerebral derangement gradually ceased to be renewed, 
and the patient was discharged from hospital in the latter part of 
March, altogether convalescent 

Case V .~~Concussion, Paralysis, Apoplexy. — A robust female 
'lunatic, chained in one of the cells of the Baltimore Alms-house, on 
account of a paroxysm of furious mania, to which she was subject at 
intervals, contrived to get at liberty, and seizing an old woman, 
(also lunatic,) who happened to be near her, threw her and struck 
her head many times with great violence on the floor. The old wo- 
man was sensible when rescued from her mad assailant, but she had 
received a severe hurt on the side of the head. There was a ragged 
cut in the left temple, and when I saw her, (half an hour after the 
beating,) the whole scalp of the left half of the head was excessively 
puffed out from the skull, by infiltration of blood. There was now 
no external bleeding from the cut, but the tumour constantly in- 
creasing, it was plain that there was still internal haemorrhage. 
The scalp was laid open across the tumour, the whole length of the 
left parietal bone, the effused blood cleaned out, and the torn arte- 
ries, (front, middle, and posterior branches of the temporal,) tied. The 
part was dressed in the common way, by a few sutures, lint, com- 
press, and bandages. 

During the incision, dressing, &c. of the scalp, the patient 
lay in a dull, moaning state, conscious when spoken to loudly, 
and sometimes replying to questions with seeming comprehension 
of their meaning, yet it was apparent that a lethargic state was 
growing on her, and from the great violence with which her head 
had been repeatedly struck on the floor, it was likely that the brain 
had suffered some lesion more direct and palpable than mere concus- 
sion. From the symptoms, no less than from the nature of the in- 
jury, extravasation within the head was apprehended as a probable 
complication. The patient was quiet, except low moanings; through 
the evening of the day of her hurt, capable, though with difficulty, of 
being roused to consciousness, and then taking part of the light nou- 
rishment offered her. Pulse small and weak, urine flowing involun- 
tarily, bowels inactive, until moved by enema. On the next morning, 
patient very listless, breathing slowly, and with long puffing expi- 
ration. Left side of the face now somewhat retracted; right cheek 
relaxed, lower lip dropping in right angle of the mouth, paralysis 
of right upper extremity. Patient showed signs of comprehension, 
but could not speak. In the morning of third day from the injury, 
patient comatose, stertorous breathing, apoplectic manner, still 

No. XV.— May, 1831. 4 



30 Wright's Baltimore Alms-house Reports. 

breathing out, in the puffing or smoking way; total paralysis of right 
side$ distortion of face; pupil of right eye dilated; pulse very small, 
surface temperature low. Died in the evening of third day. 

Dissection twenty hours after death. — Much red serosity on cra- 
nial surface of dura mater, exfiltration post mortem — same fluid in 
abundance between dura mater and arachnoid. Superficial viens 
very full of black blood. On the right posterior lobe of cerebrum, a 
small coagulum, about a scruple weight of extravasated blood involved 
in cellular tissue of pia mater. Copious serosity by gravitation around 
the cerebellum and medulla oblongata. Medullary pulp of cerebrum 
softening, not otherwise denatural. Lateral ventricles dropsical, sup- 
posed three to four ounces, old deposit.* Serous membrane of ventricle 
very pale, plexus choroides atrophied, one or two vesicles, hydatiform, 
— attached to plexus, in posterior corner of ventricles. When the an- 
terior cornu of ventricles was displayed, the left corpus striatum 
presented an unnatural yellow-brown appearance — cutting into the 
coloured part of this body, disclosed extensive abscess degeneration 
of its central portion. It seemed an old incavation, partly empty, 
but still containing some glutinous puriform fluid, resembling brown 
soft soap. The cyst, if full, might contain about two drachms. 

Remarks.— The state of the brain in - this case left the main pur- 
pose of investigation unexplained. At most, the marks and degree 
of encephalic lesion were insufficient to remove doubt as to the di- 
rect mode of interference with the cerebral functions, by which death 
was caused. There were no traces of inflammation, or special con- 
gestion, in the brain or membranes, and there were no signs during 
life of inflammation. The clot of extravasation on the right cerebral 
lobe, was too inconsiderable to account for the lethargy, paralysis, 
apoplectic stupor, and death. The water in the lateral ventricles 
had nothing to do with the derangement of the sensorium, by which 
the functions of animal life. were fatally invaded. The accumula- 
tion had all the characters of chronic cerebro-ventricular dropsy, to 
which, when gradually formed, the brain accommodates itself without 
difficulty, and the fluid not having been effused upon the important 

* The medium septum of the ventricles was entirely demolished, and the 
two original cavities thrown into one. This obliteration of the septum was not 
here, (as is supposed to be generally the fact when the partition is broken 
down,) the result of mere distention of the ventricles mechanically tearing the 
septum, but was palpably the work of disease in the membrane itself. There 
Was left an arched border of the septum along the under margin of the ra- 
phe, which was thickened, and showed a distinct ulcerous line. The septum 
bad been melted away by ulceration 



Wright's Baltimore Alms-house Reports. 31 

nervous textures, (of respiratory life,) about the cerebro-spinal union, 
its presence in the upper cavities was comparatively indifferent, do- 
ing little harm while there, and only dangerous from its liability to 
get suddenly elsewhere. 

The agency of concussion in the case, is entitled to particular con- 
sideration, from the peculiar fitness and direct tendency of the man- 
ner of injury to produce that result. It was stated, that the patient's 
head had been struck forcibly against the floor many times, so as to 
cut through the integuments, break the principal branches of the 
temporal artery, and load the scalp with extravasation. But the 
phenomena during life, differed in many respects from the signs of 
concussion, when so profound as to result in death by collapse. Un- 
consciousness was gradual, not sudden; there was hemiplegia, with 
partial tonic spasm, not universal or equal impairment, or extinction 
of motivity. The full or final developments were those of positive 
oppression of the brain — not mere suspension of the cerebro-vital 
functions. Venous engorgements were palpable all over the surface 
of the brain, and the sinuses full. Concussion, and extra venous 
congestion concurrently, aid the diagnosis; but leave to conjecture 
the partial form of paralysis, with the interval of intelligence preced- 
ing apoplectic consummation. 

It was noticed in exploring the cerebellum, that the fourth ventri- 
cle was preternatu rally large, and cavernous, as if having been dis- 
tended by fluid. It was empty, with a small laceration near its in- 
ferior sinus. Whether it had lately contained water which was 
effused by the violence done in striking the head, or the mem- 
brane of the ventricle was rent in handling the brain, cannot be 
discriminated. The dilated state of that cavity however, imply- 
ing previous dropsy there, as well as of the lateral ventricles, the 
rent in the floor of the fourth sinus, and the effusion of its fluid, 
indicates a probable auxiliary explanation of the symptoms, and 
issue of the case. The suggestion offered by some pathologists, 
that the sudden death frequently ensuing to general dropsy, might 
be caused by abrupt descent of fluid from the lateral ventricles, 
on the nervous origins about the cerebro-spinal junction, has appeared 
to receive confirmation by examinations* I have made to detect the 
source of that phenomenon. In the present case, it is possible effects 
similar in kind may have owed their occurrence to a previous dropsical 
state of the fourth sinus, and the sudden diffusion of its fluid. The 
less immediate, or rather the less decisive interference with the vital 



* Communicated in "American Journal of the Medical Sciences," for August, 

1828. 



32 Wright's Baltimore Jilms-house Reports. 

forces of respiration, circulation, &c. in the present, than in the for- 
mer class of cases, may perhaps be referred to the comparatively 
weaker shock from minor quantity of the embarrassing agent. 

A question of some interest, touching the physiology of relation 
between the brain and nervous system of motion, presents itself to 
notice, in connexion with one of the revelations of the foregoing case. 
In the distribution of the physical functions, (mainly the animal vital 
properties,) over which the brain presides, to special portions of the 
cerebral organism, distinguished physiologists have assigned to the 
corpora striata, the office of regulators of the locomotive acts of the 
lower extremities, the directors, or guides of movement — not the 
source or imparters of the motive power. To learn how far, 
or in what way the regulating power of movement was affected 
by the palpable lesion of the corpus striatum in the present in- 
stance, particular inquiry was instituted, touching the common 
manner and carriage of the patient. The information obtained of 
those having charge of this person as a lunatic was, that nothing re- 
markable was known respecting her ordinary personal manner or gait. 
The woman was described as inclined, like other lunatics, to move 
about a great deal, that she went often into the yard of exercise at- 
tached to the department of females, and appeared in general to walk 
as well as others of her age.* In reply to the question, whether the 
woman had been observed to become at times unsteady in her walk, 
apt to lose her balance, and either fall, or have to hold by something 
for support, it was stated by the keeper of the cells for females, that 
she had often remarked the subject of the question to totter con- 
siderably, or u stagger" so much at times, especially on first rising 
up, and attempting to move forward, as to appear not to have full 
command for the moment of her lower limbs. The woman, however, 
was not known to be more liable than others, to get falls, nor did 
she need support or aid in walking. Nothing more satisfactory could 
be learned on this head, and it remains doubtful, whether the old de- 
generescence of the left corpus striatum had any connexion with the 
occasional unsteadiness, spoken of by the keeper of the female lu- 
natic department. Even had the imperfection of voluntary motion 
been more palpable and constant, than would seem to have been the 
case, the direct or exclusive connexion of that fact, with decay of the 
corpus striatum could not be realized, inasmuch as there was other 
states of the brain calculated to derange its physiological attributes 
of relation with the animal functions. There was old and large 

* The subject of these inquiries was about fifty years of age; of full person,, 
and had enjoyed general good health. 



Wright's Baltimore Alms-house Reports. 33 

dropsy of the lateral -ventricles, and appearances of a previous simi- 
lar condition of the lesser serous cavities; there was also an obvious 
general character of relaxation and atony, (if it may be so express- 
ed,) of all the elementary textures of the encephalon. The brain 
and its coverings were soft, flaccid, watery, and, (with exception of 
the surface veins,) for the most part colourless. 

The total state of the encephalon in this subject, previous to the in- 
jury which proved fatal, only serves to illustrate anew, that the ce- 
rebral organism may be profoundly diseased, without external marks 
corresponding to the nature or extent of the existing lesion. 

Case VI. — -Meningitis — Tuberculoid Degeneration. — A man aged 
thirty-nine, tall, spare form, was admitted, November 14th, 1829, 
on account of chronic head-ache, of long standing, which, by its con- 
stancy, as well as degree, had rendered him wholly unable to pur- 
sue his ordinary occupation. 

The only complaint in the present case was of a dull, oppressive, 
unremitting head-ache, not violent, but which, by its uniformity and 
long-continuance, had rendered the patient unable to follow any 
business. The disorder of head was represented to have commenced 
three years before, in paroxysms of various interval and duration, but 
now for many months greater than formerly, and scarcely at all re- 
mitting. The whole head sore and aching; pain always greatest in 
the occipital region. 

This man's appearance was striking. Face long and thin; coun- 
tenance dejected, dull, and invariable; eyes protruded, with a 
vacant unmeaning look, as if there existed in the mind, no other 
interest or consciousness than the perception of the pain in the 
■ head, in which every other intellectual sense appeared to be absorb- 
ed; eyes unnaturally prominent, axis of the pupils directed forward, 
and habitually fixed in that aspect; pupils large, vision perfect. 
Mind sluggish and abstracted, perceptions dull, speech slow and 
monosyllabic; sense of hearing natural. 

The whole of the animal functions in this case betrayed marked 
defect of natural excitement; nothing appeared of the reactive pro- 
perty, denominated, (by Broussais, with seeming propriety,) vi- 
tal erection. Physical inertia prevailed every where; the tem- 
perature was low, pulse slow and weak, respiration small, bowels 
torpid, movements languid, still there was little palpable constitu- 
tional pathology. There was no fever, tongue clean, appetite^ suffi- 
cient, nutrition moderate, no pain in any other seat than the head. 
At the time of admission, the patient was not in a state to need con- 

4* 



34 Wright's Baltimore Mms-house Reports. 

finement to bed, and though commonly lying down, he frequently 
moved about in the listless indifferent way, which characterized all 
his manner. 

Diagnosis. — All the symptoms seemed to indicate an abnormal 
state of part of the encephalic textures. A portion of the meninges 
were supposed to have undergone some thickening, induration, or ul- 
cerous decay, tardily consummated by low chronic inflammation of 
those textures. Part of the membrane of the cerebellum was in- 
dicated as the probable seat of degenerescence. 

Treatment. — This was limited for some time to the renovation 
of excretions by the bowels and skin, by the exhibition of ca- 
lomel, guaiacum, and compound extract of colocynth, in doses to 
move the bowels, short of purging; the tepid bath, with after sur- 
face friction, employed concurrently; cups to the hind head and 
neck, were the first local mean; afte wards vesicatories in succes- 
sion, and from defect of relief, or palliation of pain, by either, 
vegetable caustic was laid over the occipito-cervical junction, and 
after separation of the eschar, kept in the state of an issue. None 
of those means accomplished any salutary change in the circum- 
stances of the case; pain of the head remained uninterrupted and un- 
diminished; the constitutional state not sensibly altered. The general 
treatment at an after period was chiefly by tonics of the mineral 
class, with aperients; the form mainly employed, carbonate of iron 
in liberal doses, combined with rhubarb and soda, in small por- 
tions: antispasmodics were also exhibited in connexion with tonics. 
The valerian, often exercising peculiar and powerful controul over 
cephalic neuralgia, was tried freely, at one time in combination with 
the carb. ferri — again with infusion of bark and aromatics. 

Nothing that was done, altered or improved the state of the case. 
The patient's account of his feeling was every day the same, his 
look and manner underwent no other change than a slow increase of 
the dull inertia of mind and body, remarked on first admission. That 
torpid state augmented continually, and arrived at last to nearly 
total defect of all motive inclination; the patient keeping always the 
same posture of body, interested in nothing, never speaking, except 
when addressed, and then only to repeat, that he had pain in his 
head: the latter was now constant. The man eat regularly, very 
moderately; had no fever at any time; no pulmonary, gastric or intes- 
tinal complication. All medical treatment was omitted after a few 
weeks. 

At the end of two months after admission, this man appeared much 
the same, in all obvious respects, as at first, some small emaciation 



Wright's Baltimore Jllms-house Reports, 



OO 



only excepted. Early in the third month, (February,) the movement 
of the upper limbs became imperfect and unsteady. At first both 
arms showed inaptitude to motion, with tremor; afterwards the 
right betrayed most inability, and soon became absolutely paralytic, 
the left continuing feebly obedient to the will. In losing all power 
of movement, the right arm had acquired an increased sense of 
touch: lifting it from the bed, or handling it lightly, gave pain, of 
which the patient complained, by exclamation, moaning, and con- 
traction of face. The limb was not swelled, or hot. Early after 
paralysis of the arm, the right thigh and leg were similarly affected, 
becoming incapable of voluntary movement, tender and painful when 
touched, pressed, or moved. It was noticed about the same time, 
that the head was getting turned to the right, with some retraction, 
and the appearance of contortion and shortening in the neck. The 
patient was incapable of correcting the wrong posture of the head 
himself, and all attempts to change it by others, gave him pain. To 
those symptoms succeeded continuous decay of the intellectual pro- 
perties, marked by imperfect and incorrect perception of what was 
said to him; irritative replies to questions; stammering, and at last, 
extinction of articulate speech. Profound indifference, and refusal 
of every thing ensued; stupor supervened, and the patient died in 
March, nearly four months after entering the Infirmary. 

Examination twelve hours after death. — On removing the crown 
of the skull, the seat of disease displayed itself at once. The dura 
mater covering both cerebral lobes behind, was degenerated, and # ul- 
cerous over a space of many inches. Further investigation showed 
the diseased portion of the great meninx, involved and matted toge- 
ther, with the arachnoid and pia mater, the whole thickened to a great 
degree, and full of abscesses; the morbid texture sinuous in places, 
and ragged by ulceration. The membranes within the limits indi- 
cated, had lost entirely the natural form and display of those tex- 
tures, and were blended in all the confusion of soft tuberculoid con- 
version and decay. The diseased mass adhered intimately to the 
surface of the brain, but the substance of the latter was not sensibly 
altered below the line of connexion; the surface of relation with the 
morbid membranes was blackened. No other lesion was discovered 
within the head, and nothing morbid about the spinal cord. 

Remark. — The subject of this report had suffered almost unre- 
mitting head-ache for nearly three years. Did the pain in this case 
follow the inceptive and advancing stages of the local development 
in the membranes of the brain? or was the latter incident to primary 
and prolonged neuralgic irritation in that seat, and conversion of 



36 Wright's Baltimore Alms-house Reports. 

structure, the consequence, rather than the cause of pain, &c. ? Of the 
nature of tuberculoid conversion in textures, we know too little 
to be able to say how they are produced — or whether inflammation, 
strictly speaking, is a necessary precedent to their beginning, or 
consummation. In some textures — (mucous and cellular tissue, 
where very vascular) — tuberculoid degeneration is often blend- 
ed with a mode of sub-acute phlegmonous inflammation. In other 
textures, both compound and simple, muco-serous, fibrous, or fibro- 
serous, (skin, fasciae, the fibrous membranes, &c.) tuberculoid con- 
densation is frequently accomplished without the concomitants of 
pain, swelling, heat, colour, &c. proper to inflammation. The dis- 
tinctions of the red and the white inflammations, the indolent, and 
the active, may be thought sufficient in their modes and degrees, to 
explain the obvious differences in the progress and result of the 
changes of structure, but it is hardly yet clearly established, that es- 
sential inflammation is the uniform attribute of all degenerating or 
converting processes, in organized textures* 

Case VII. — Hemiplegia — Exalted Sensibility.* — A black man, 
aged fifty, large frame, muscular, but wasted, was admitted, Decem- 
ber, 1829; complaint general debility, infiltration of the lower limbs, 
inability to walk, and fixed pain in the back of the head. Patient said 
that he had been suffering from head-ache five weeks, and had gra- 
dually lost his strength till he was no longer able to go about, dur- 
ing the last few days his lower limbs became swelled. 

At the time of admission, the patient was unable to support him- 
self standing, and felt giddiness with pain of head on being raised 
up; pain chiefly in the back of the head, occipital region sore to 
pressure. There had been no hurt of the head, by a blow, fall, &c. 
as the probable first occasion of pain and soreness in the part. The 
general state of the patient betrayed prolonged constitutional irrita- 
tion. Eyes slightly injected and watery— tongue dry, white — villi 
raised, surface gluey — pulse small, with frequency — skin dry and 
harsh — breathing slow. Abdomen collapsed, muscles of the belly 
rigid, epigastrium sore, bowels inactive; no palpable visceral com- 
plication. This man had been a patient of the house nine months be- 
fore; admitted then on account of partial insanity, ensuing to fits of 
the convulsive form, supposed to be caused by intemperance. By 
rest and restraint, he had become well, was discharged, and now re- 
turned in the state described. 

Treatment for the present was palliative of constitutional derange- 
ment, and directed chiefly to the surfaces, internal and external of 






Wright's Baltimore Alms-house Reports. 37 

excretion. Mild aperient agents, in under doses frequently renew- 
ed, were associated with general sponging by tepid spirituous fluids; 
diet simplified, and regulated. Cups to the epigastrium were em- 
ployed concurrently, with the means indicated; succeeded, after 
some days, by epispastics to abdomen and legs. The case altered 
little for some time, presenting continually, in all the systems of nu- 
tritive life, the same characters of low irritation which it was mainly 
the design of the simple medical plan to gradually extinguish. Pain 
of the head was constant, imbecile intellect, general inability of mo- 
tion, soreness in all the soft parts; torpid bowels; tender belly; tongue 
red and dry, &c. 

Friction with more stimulating agents; strong rubefacients were 
renewed actively over the trunk, and along the spine; and about the 
cervico-dorsal tract of the latter, the potass caust. was applied at 
defined points on both sides, in a manner substituting the action of 
moxas. The less exciting tonic agents were at the same time combin- 
ed in exhibition with the sedatives of irritation, aqueous solution of 
extract of quinine, with the neutral diaphoretics; diet and drinks ren- 
dered lightly cordial; under every modification of treatment, the 
patient reduced slowly, lost inclination for every thing, except weak 
cordials; became dull and drowsy, eyes injected, posture of body 
invariably to the right side, bowels almost invincibly constipated, 
urine scant, pulse small, slight feverishness. 

Early in January, third week in hospital, hemiplegia was reveal- 
ed. When first discovered, paralysis was incomplete; the right infe- 
rior extremity was wholly immobile by will, while the right arm could 
still be moved by the patient, though it was benumbed and stiff, com- 
pared with its fellow. The whole right side, head, limbs, and trunk 
were sore to touch, and handling and lifting the limbs of that side 
gave great pain. In a short time the upper, as well as lower right 
extremity was totally palsied; retaining, however, extra sensitive 
property. The head of the patient was now directed constantly to 
the right side, and drawn back, as well as turned, so as to present 
that appearance known by the term wry neck. Attempts to move the 
head towards its natural axis gave great pain; pressure near the 
occipito-cervical junction caused shrinking, exclamation, and distor- 
tion of face. The right eye became involved in deep conjunctivitis, 
impairing vision; left eye slightly affected in the same way. 

In the further progress of the case, cerebral excitability was ex- 
pended to the point approximating extinction of the intellectual 
functiohs. Attention by the patient was excited with difficulty, and 
existed but for a moment, followed by drowsiness, almost amount- 



38 Wright's Baltimore Jllms-house Reports. 

ing to positive stupor. The sensitive property of the textures 
was elevated unduly, as the sensorial power was depressed. All the 
surface of the body, every tangible part showed an acute sense of 
soreness to pressure, however slight. The patient died the 20th of 
January, 1830. For many days before death, vision was totally lost 
in consequence of the occupation of the anterior chamber of both 
eyes by a dense yellow pus. 

JExamination.->-The head being opened in the common manner, 
the dura mater showed its natural appearance, without marks of en- 
gorgement, inflammation, or other change. On turning this investure 
back, so as to uncover the proper tunics of the brain, the membranes 
of the posterior cerebrum were overspread by a large amount of pale 
red albuminous matter. When this was wiped away, something pre- 
sented in the same space, having the appearance of a flatted tumour, 
overlaying and compressing in some degree the occipital portion of 
both hemispheres of the brain. The foreign substance was found, on 
further examination, interposed between the arachnoid and pia ma- 
ter, detaching and elevating the former tb the extent of some inches; 
it cohered to the pia mater with considerable firmness, but was sepa- 
rated by the fingers, and taken up entire. The mass as removed 
was ash-coloured, semi-solid, lacerable, but tough, exhibiting none 
of the characters of organized texture. On close examination, the 
true character of this substance became manifest; its central portion 
betrayed what it was by retaining distinctly something of the colour 
as well as other qualities of old coagulated blood. The surface of 
the brain appeared flatted for the space covered by the coagulum; 
the membranes above and beneath the clot were dark-coloured. 

Remark.^- From the breadth and thickness of the coagulum yet 
remaining, the amount of extravasation it represented must have been 
some ounces. At what time the blood was poured on the brain, and 
whether suddenly, by haemorrhage, or gradually by a species of ex- 
halation, is matter of conjecture. The patient had been affected at a 
former period by convulsions and partial insanity; he came into hos- 
pital five weeks preceding death, with head-ache, in the back of his 
head especially, giddiness, low excitement, and great muscular de- 
bility. But at that time, the cerebral functions of intellect, the 
senses, consciousness, &c. were in the normal state, and were only 
gradually abolished, by sensorial and constitutional exhaustion, in the 
last week of life. Although the history and prior circumstances of the 
case denote the existence of serious chronic irritation of the brain, 
and hence proclivity to pathological developments there, it is yet 
probable from the course and order of cerebral symptoms, that the 



Wright's Baltimore Alms-house Reports, 39 

blood effusion, to the extent found, was an affair of slow accomplish- 
ment. Extravasation may have commenced before or after the pa- 
tient's admission into hospital, and which was the fact, there is no 
means of proofs but in either case, it is most likely the accumulation 
was completed by successive escape of small quantities of blood from 
the vascular plexus of the pia mater, than by active hemorrhage. 

The analogy of symptoms and phenomena in the two last cases is 
close and striking. Head-ache, same region of the head, prolonged 
into chronic and constant pain, was the primary and prominent af- 
fection in both cases. At a period, about equally remote from the 
crisis of each, total hemiplegia occurred to both, attended by super- 
sensitiveness to touch over the whole body of each patient, and with 
that property especially and alike exalted in the paralyzed parts. 
Retroversion to a degree, retraction and fixedness of the head to the 
right occurred in both, and in each the catastrophe of the case was 
accomplished in gradual abolition of consciousness, stupor, and death, 
unattended by any kind of tumult or struggle. But the parallel was 
not entire in the two cases; the constitutional state of the patients 
differed materially in some important points. In the one case, the 
forces and actions of physical life, exhibited a character of sim- 
ple impassive atony, almost wholly negative of essential or con- 
stitutional pathology. In the other, (second case,) the vitalism 
and Junctions of the apparatus of nutritive life, organisms of relation 
and sympathy, betrayed every where the impress and the forms of 
deep and permanent irritation. It is not a little remarkable, that the 
most palpable departure from the normal constitutional state should 
have occurred in that one of the two cases, in which the local cause, 
(the only obvious cause in either,) of derangement, was apparently 
the least qualified to produce the greater disturbance in the total eco- 
nomy. The interference with the cerebro-vital functions in the latter 
case was by a cause which seemed to have acted mechanically and 
slowly — while in the former instance/part of the encephalic organ- 
ism, the nutrient textures of the brain itself, were thoroughly dis- 
eased and degenerated. The rationale of consequences, so contrast- 
ed and unlikely, under the circumstances, is not easily made out, 

Case VIII. — Dropsy of the Head— -Secondary Hemorrhage. — The 
following case, admitted into the Baltimore Alms-house, 14th of 
November, 18S0, came under examination 15th of same month, 
Charles Berry man, African, forty years of age, person large, very 
muscular, countenance vacant, eyes natural, look heavy, position 
supine, whole manner inert and listless, no fever, pulse regular 



40 Wright's Baltimore Mms-house Reports. 

and soft, stroke about 65. Patient' rational but heedless; answers 
slow and brief; acknowledges dull head-ache; no other pain; appetite 
good; bowels costive; general muscular debility. Voluntary motive 
power equal every where. 

No other history of the case could be obtained of the patient, than 
that he was by occupation a sailor, cook of a vessel, had been weak 
and unable to do any thing for two months, knew no cause for his in- 
firmity, had not been hurt, was not sensible of any other disorder 
than head-ache and debility. Head was explored; no mark of injury 
and no defect of form. 

Diagnosis was obscure and difficult. A normal state of part of the 
brain textures was indicated. Pressure by slow fluid accumulation 
or tunic development, otherwise induration or softening of medul- 
lary tissue; seat of special embarrassment above tuber annulare, whe- 
ther central pulp, striated body, or optic couch. The patient was 
requested to get up and walk; body bowed forward, arms thrown out 
and dangling, gait staggering. 

Patient was taken in charge of Mr. Selden of the student class; 
general instructions — moderate purging, (compound senna infusion,) 
diet farinaceous, rest in bed; if head-ache rose to pain,'iocal or gene- 
ral bleeding, guardedly, according to indications. 

After being a few days in hospital, patient was observed to fall oc- 
casionally, particularly at night, into a kind of illusion allied to mild 
insanity. He talked or muttered to himself, as it seemed, unconsci- 
ously, and was in the habit of getting up at night, going to the bed 
of other patients and pulling off the bed-clothes; sometimes he would 
place himself by one of the beds, and mistaking it for the stove, 
stretch out his arms to it in the manner of one warming his hands. 
Of both those errors he was unaware, and on being told of his wan- 
derings, denied the fact; when it was insisted that he pulled the 
clothes off other patients in the night, he said he did not know it, and 
that they were fools to let him do so. To prevent his wandering at 
night, a fastening was put on his leg at bed time. This man improv- 
ed slowly in appearance, and in the functions of mind and body. He 
became quiet and regular in conduct, more animated and lively, 
even jocose at times, particularly about his light fare, and acquired 
much more power and controul of his movements, than when re- 
ceived. He almost ceased to feel head-ache, and the chief error of 
health was torpid bowels, for which it was necessary frequently to 
purge him. At his own earnest solicitation his diet was made more 
substantial, and soon after, (5th of December,) he was discharged 
hospital, reported for light work. 



Wrights Baltimore Alms-house Reports. 41 

Late in the same month, 25th of December, while carrying an arm- 
ful of fire wood down a short flight of steps, Berryman fell, and al- 
most immediately was seized with convulsions, which lasted about 
half an hour. Mr. Selden saw him during the fit, and finding signs 
of congestion, with a full pulse, bled him somewhat freely. Mr. 
Selden regarded the convulsion as of the epileptic form; the spastic 
actions were mainly in the muscles of the upper extremities, shoul- 
ders, neck, and face, with foaming at the mouth. The spasms ceas- 
ed with the bleeding, partial lethargy followed for some hours, but 
no positive stupor; he was conscious, but dull of being roused. No- 
thing of the straining respiration, the snort, or slow puffing breath- 
ing of apoplectic assault attended the fit, nor was it followed by sen- 
sible impairment of the moral faculties or of the voluntary motive 
powers. In a week Berryman was about again, as well apparently 
as before the fall, convulsions, &c. When he had recovered com- 
pletely from the shock of that accident, it was endeavoured to ascer- 
tain of him whether he was subject to fits formerly, or before coming 
to the Alms-house. He remembered having been attacked in the same 
way once, possibly twice before, but was certain that he had never 
been subject to fits at any period of his life, until within the last four 
or five months. He was now put on the use of zinc, valerian, and hy- 
osciamus, as antagonists of epileptic invasion, his diet somewhat re- 
stricted, and the privilege allowed him of exercise in the open air. 

Six weeks after the fall, fit, &c. 25th of December, Berryman fell 
again, 10th of February, at the out door of the hospital, while bring- 
ing a bucket of water. The same result ensued as before. He went 
immediately into convulsions,* in every respect like those with which 
he was affected on the former occasion. He was again bled by Mr. 
Selden, and slowly recovered consciousness, power of speech, &c. 
But now, instead of recovering steadily or fully, as before, he ap- 
peared on the day following the fit to be more dull and insensible 
than on the evening of the paroxysm. Something like the comatose 
state supervened, which though not wholly impenetrable, yet render- 
ed it difficult to excite any acknowledgment of recognition, or any 
reply to what was said to him. He would answer questions when much 
urged, and his replies were coherent, but he would lapse directly 
into total heedlessness. His breathing was slow and regular, eyes 
natural, pupils contractile, no paralysis; he moved all his limbs in 

* It is doubtful whether the falls caused the fits, or sudden congestion of the 
brain, precursory of the fits, caused him to fall. In the last instance, the door 
step being- covered with ice, he was observed by persons present to slip, and 
seemed to fall on that account. 

No. XV.— May, 1831. 5 



42 Wright 's Baltimore Jllms-house. Reports. 

turn, when made to comprehend the request to do so. Sinapisms, 
stimulating enemata, and vesicatories were employed without bene- 
fit. He fell off gradually, and died on the sixth day from the last fit. 
Slight muscular convulsions supervened once or twice the day before 
his death. 

Examination of the head twenty hours after death. — Scalp very 
thick, one-fourth of an inch, and hard texture, resembling the tawny 
fibro-ligamentous tissues. Skull thick, compact, thorough ossification, 
no palpable intertabular texture; fossae of convolutions deep and 
strongly-marked. Dura mater general purplish hue from engorge- 
ment of the superficial veins of the convolutions. When this mem- 
brane was cut round, and lifted off the hemispheres, the surface 
of the left anterior and midlobe presented an appearance I have not 
seen before on the surface of the brain. The colour of the region in- 
dicated was a deep brown-yellow, with a tinge of green, giving an 
appearance very much resembling a fresh smoke stain, particularly 
from green wood, on a white ground. The hemispheres, (brain pulp 
firm,) being sliced down to the level of the commissur. mag. it was 
discoverable by the touch that the ventricles were replete with fluid. 
By a slight incision in their length, dividing all but the membrane of 
the cavities, the reflection of their contents was so distinctly reddish 
that it was pronounced to be blood. When discharged, however, it 
proved to be water, and translucent, but with a strong red tinge. 
The ventricles were exceedingly dilated, the septum entire, but the 
communication being free by the foramen, (of Monro, greatly en- 
larged,) under the anterior crus Of the fornix, the two cavities were 
essentially one, and formed a great cyst capable of containing many 
ounces, in the centre of the brain. The lining of the ventricles was 
sensibly thickened, of a dull yellow colour, and disposed to separate 
or peel off easily from the sides of the cavities. The fornix being 
raised, the passages before and behind, to the infundibulum and the 
fourth ventricle, were each enlarged very much, sufficient to admit 
the point of the finger. The corpora striata and thalami were na- 
tural. 

Up to this stage of the examination, nothing was found in the state 
of the brain, satisfactorily explaining the latter symptoms and the ca- 
tastrophe of the case. On raising the inferior portion of the front lobes 
of the brain, they were no longer distinct as usual, constituting the 
hiatus anterior cerebri, but were closely cemented by tough lymphy 
matter of apparently old formation. When torn apart, the surface of 
attachment showed the same smoke-stained hue, that was so distinct 
on the external aspect of the left hemisphere. As soon as the lobes 



Wright's Baltimore Mms-house Reports. 43 

were freed from their cohesion at and behind the falx, and lifted from 
the basilar fossae in front? all uncertainty about the seat and nature 
of the fatal lesion, was at once removed. The whole anterior inferior 
surface of the left hemisphere, was enveloped in a mass of semi-solid 
black-red grume, evidently from blood extravasation. The arachnoid 
and pia mater, very much injected and distended, appeared to form 
the web or cyst of the effused and partly decomposed blood, and 
when it was attempted to lift the part higher, for better inspection, 
the membranes burst, with a copious issue of matter of thick consist- 
ence and grayish-red colour,* followed by collapse and seeming loss 
of considerable part of the hemisphere.t Upon further search a free 
communication was found, (rather a continuous cavity,) leading into 
the left inferior cornu or sinus of the ventricle on that side, which 
was filled as high as the mouth of the sinus, with very black grumous 
blood. The posterior cornu of the left ventricle was also nearly 
filled with the same matter, and both the middle and posterior horns 
of the right ventricle contained some blood, (half dissolved and gra- 
vitated to the end of the sinuses,) which had found its way into those 
cavities by the foramen under the fornix. The reddish tint of the wa- 
ter of the ventricles was thus explained; the grosser part of the blood 
had precipitated, leaving the water stained. 

The source of extravasation was readily discovered, and consider- 
able as the effusion was, we were surprised that it had not been 
greater, nay instantly fatal, when a vessel large as a crow-quill was 
found to be the point of haemorrhage, and that vessel completely 
broken or torn fairly across. It was the root or trunk of the cerebra- 
lis media, the proper carotid within the head, ruptured about half an 
Inch above the triple branching of that artery by the side of the sella 
turcica. The basilar or cardiac end of the artery was plugged by a 
coagulum protruding a little from its mouth, and filling the lumen of 
the vessel for a quarter of an inch. In attempting to disengage the 
coagulum, the artery broke, by only slight force, below the internal 
end of the clot; the coats of the vessel at the place of first fracture, 
were not palpably diseased. It was remarkable that an artery of such 
magnitude, suddenly truncated, at a point where it carries so full a 
current, should not have given out more blood than was shed; and 
not less so, that the delicate tunics of the brain, pia mater, and arach- 
noid, should have served to detain the injected blood from all effu- 



* Like broken pulp of brain and blood mingled. 

f The brain tissue was broken down, diffluent, and mixed with blood, for 
gome extent around and within the digital cavity of the left sinus. 



44 Wright's Baltimore Alms-house Reports. 

sion on the base of the skull, and cause it to open a way through part 
of the medullary pulp into one of the central cavities, 

It would be satisfactory, if it were possible, to know at what time 
the breaking of the artery in this case occurred. Can it be supposed 
to have happened at the time of the first fall the patient got, as de- 
scribed, six weeks before death, and that he was able to go about, as 
he did, for more than five weeks after such lesion, apparently as well 
as before the^accident? This was my first impression. Judging from 
the dark, gelatinous state of the blood, its complete precipitation in 
the water of the ventricles, and the reduced diffluent condition of 
part of the brain pulp, I conceived those changes must have required 
something like the time intervening from the first fall to the end of 
the case. On reflection I think that judgment erroneous. It is diffi- 
cult to reconcile the functions and powers of the patient in the inte- 
rim, with so great injury of the organ of the senses, of intellection, 
and the regulator of the voluntary motions. It accords better with 
the total phenomena of the case, to date the rupture of the artery at 
the epoch of the last fall, six days before death. The water in the 
ventricles was clearly an ancient evil. The moral and physical in- 
ertia of the patient, at and before admission, his constant dull head- 
ache, with occasional partial insanity or state of illusion, his weak- 
ness, tremors, and staggering gait, all import the long existence of a 
cause so likely to produce the class of symptoms always present in 
the case. It may be added, that the colour of the ventricular mem- 
brane, its thickened and easily separable state, confirms the proba- 
bility, that the fluid accumulation, the effect of former inflammatory 
action in themembrane, was of comparatively remote accomplishment. 
On the day following the man's death, his brother came to the house, 
and on being questioned as to his knowledge of the primary affection, 
reported, that during the past summer, his brother, while acting as 
cook of a vessel, on one occasion slept all night on deck, and was 
thought to have been moon-struck, (the expression used,) for that he 
was found next morning disordered in intellect, and otherwise un- 
well, and had continued feeble, and occasionally wrong in mind ever 
since; 

The case just reported, brings forcibly to mind one recorded by 
Mr. Bell, and which will be found in the Periscope of the present 
Number, Sect. Pathology. 

Baltimore, Feb, 1831, 



Mott's Case of Ligature of Carotid. 45 



Art. II. Description of the Circulation of the Head and Neck in a 
Case after one Carotid Artery had been Tied. By Valentine 
Mott, M. D. Professor of Surgery in the College of Physicians 
and Surgeons of New York. [With two Plates.] 

1 TIED the carotid artery in this case for the safe removal of a car- 
cinomatous tumour, situated upon the right side of the face and neck, 
and occupying a considerable portion of each.* 

Shortly after the operation the patient was attacked with a pulmo- 
nary affection, under which he gradually sunk, having lived three 
months and nineteen days. 

I gladly availed myself of the opportunity of obtaining the head 
for dissection, in which I was assisted by Drs. David L. Rodgers 
and Alexander F. Vache, who were at that time my pupils. The 
head was removed from the body by sawing through the sternum, 
so as to leave the clavicles attached, the superior extremities were 
removed from the trunk, and the dorsal vertebrae and ribs divided 
between the second and third, so as to leave it of a bust-like shape. 
This preserved the shoulders in such a way, that the subclavians 
and their branches might be injected. The ascending arch, and 
a portion of the descending aorta, were also included in the prepa- 
ration. 

To secure the filling of the arteries of the head and neck, a long 
pipe was passed up the aorta into the left carotid, and a fine wax in- 
jection was thrown in with great care, and as the subsequent account 
will show, with great success. The aorta was next injected to fill 
the subclavians and their branches. 

The following description of the arteries is taken from the prepa- 
ration, and they are delineated as far as possible in the annexed en- 
gravings. 

1st. The arteries that supplied the right side of the face and neck. 
See Plate J. 

To give a regular description of these arteries would be incompa- 
tible with the principle of collateral circulation; inasmuch as they are 
found to vary in different subjects, for " the inosculation is never 
carried on by any particular set of vessels, but by all the arteries of 
the. neighbouring parts." 

Upon removing the integuments on the forepart of the neck, and 

* For an account of this case see " The Medical and Surgical Hospital Re- 
gister," New York, 1818. Vol. I. Part II. 

5* 



46 Mott's Case of Ligature of Carotid. 

laying bare the carotid artery, from the innominata to the angle of 
the jaw, its caliber was found completely obliterated from its origin 
to its bifurcation, leaving a firm, ligamentous cord, which was di- 
vided into two parts, showing the place where the ligatures had been 
applied.. 

The vein and nerve were perfectly natural. The right subclavian 
was much enlarged, being equal in size to the innominata from its 
origin to the scaleni muscles. 

The left carotid was enlarged to twice its natural diameter, its 
branches increased in the same ratio, and assumed a tortuous and ir- 
regular course. 

When we take into consideration the connexion which the arteries 
of the left, have with those of the right side of the head, and their 
free inosculation with the subclavian, we have in our minds the 
branches which must necessarily supply the place of the right carotid. 
First, we have the branches arising from the subclavian, which are 
very numerous; second, those arising from the left carotid, which are 
still more numerous. 

A minute detail of the numerous vessels which communicate with 
the carotid, would be tedious and uninteresting, and would perhaps 
be impracticable were it deemed expedient. Suffice it to notice the 
principal branches, and to give a general description of the smaller, 
but no less beautiful inosculations. We find then, arising from the 
right subclavian, first, the arteria thyroidea inferior; second, the cer- 
vicaiis profunda; third, the cervicalis superficialis; and fourth, the 
vertebral arteries. 

The inferior thyroid, as it arises from the subclavian, divides into 
four branches: two passing downward and outward, and the other two 
passing upward; the latter are called the ramus thyroidea, and the 
thyroidea ascendens. These require particular attention from their 
large size, and the important supply of blood which they furnish for 
the support of the arteries of the neck. While the superior arteries 
were enlarged to twice their natural diameter, the two inferior, viz. 
the transversalis colli and the transversalis humeri, although arising 
from the same trunk, and receiving their currents of blood in the 
most favourable direction, still retained their natural dimensions. 
But this phenomenon usually occurs in the circulating system. John 
Bell observes, " that in whatever way the demand of blood upon an 
artery or set of arteries is increased, the effect is an accelerated mo- 
tion of blood towards that artery." And again, "any demand of 
blood causes an enlargement of the arteries, leading to the part which 
demands the blood. " 



Mott's Case of Ligature of Carotid, 47 

Guided then by this principle, we need not be surprised that the 
subclavian is so much enlarged from its origin to the scaleni mus- 
cles; for here it affords a supply of blood to new and important parts. 
The ramus thyroideus passing upward to the thyroid gland, and anas- 
tomosing with the superior thyroideal artery, was one great source 
of blood, its branches were large and tortuous, forming communica- 
tions in every direction with those from above. 

The thyroidea ascendens is naturally a small and unimportant 
branch; it was here three times its usual size, mounting up the neck 
in a zig-zag direction, lying close to the vertebrae, forming frequent 
communications with the vertebral artery, dividing into many small 
branches at the upper part of the mastoid muscle, forming a beauti- 
ful plexus of vessels with the mastoid branch of the occipital artery, 
and sending branches to all the muscles on the upper part of the 
neck. 

The eervicalis profunda and superficialis, were much enlarged, 
sending frequent branches upward to anastomose with the descending 
branches of the occipital artery. By far the most important and in- 
teresting part of the circulation yet remains to be described. 

2d. The arteries of the left side of the head and neck. See Plate II, 

The left carotid passing up the neck, equal in size to the innomi- 
nata, furnished the greatest part of the blood for the right side. 

In order to determine what particular arteries were enlarged, it is 
necessary only to enumerate the branches given off from the carotid, 
and more particularly those which arise from its forepart. Below 
the jaw there are four; viz. the superior thyroid, the lingual, pha- 
ryngeal, and the maxillaris interna, which inosculate with open 
mouths, having the appearance of continuous trunks, and sending a 
plentiful supply of blood to the neck and internal parts of the face. 

The labial and temporal arteries, leaving the axilla under the an- 
gle of the jaw, passing upward upon the face, send off small branches 
in a beautiful and fantastic manner. Branches, which before were 
considered unworthy the attention of the anatomist, now rise into 
importance. The plexuses and inosculations formed by these branches 
excite alike our surprise and admiration, and elucidate, in the most 
beautiful manner, the principles of collateral circulation. These ar- 
teries, in general, are large and tortuous, and have frequent commu- 
nications among themselves. The arteries most enlarged, were the 
mental, the inferior labial, the coronary, and the angularis. The op- 
tic artery was likewise much enlarged, beautifully anastomosing with 
the angularis. 

So freely did these arteries inosculate with those of the right side? 



48 Mott's Case of Ligature of Carotid. 

that before the operation was finished, it was necessary to secure the 
labial artery in a ligature. This was clearly illustrated by the retro- 
grade course of the injection after death, which passed freely from the 
arteries of the opposite side, filling the superior portion of the labial to 
the point at which the ligature had been applied. The temporal ar- 
tery was of its natural size, receiving its blood from " all the arte- 
ries of the neighbouring parts," from the ascending branches of the 
occipital, the left temporal, the ophthalmic, and the transverse facial. 
This free communication was distinctly shown by the injection, which 
passing down the temporal, completely filled the external and inter- 
nal carotids, and several of their branches; particularly the inferior 
portion of the labial, which is seen emerging from under the jaw, to 
pass upon the face. The labial terminated at that point where the 
mental is given off. The mental passed on to its usual destination, 
and received blood from its fellow of the opposite side. 

All of these arteries will be easily and readily recognised by refer- 
ring to the plates. 

PLATE I. 

In this plate is represented the right carotid artery, obliterated 
from the innominata to the bifurcation. The success with which the 
circulation was carried on to the head, through the inosculating chan- 
nels, may also be seen in the enlarged anastomosing branches. 

Fig. 1. Right bronchial tube. 

2. Aorta. 

3. Arteria innominata. 

4. Ramus thyroidus arterje thyroidese. 

5. Sterno-cleido mastoideus* 

6. Thyroidea ascendens. 

7. Scalenus anticus muscle. 

8. Subclavian artery after it has passed the scaleni muscles. 

9. Transversalis humeri of its natural size. 

a. Transversalis colli. 

b. Cervicalis superficialis et profunda. 

c. Portion of the carotid separated by the ligatures. 

d. Obliterated carotid. 

e. Superior thyroidal artery. 

/. Inferior portion of the labial as divided in the operation. 

g. Mental artery. 

h. Superior portion of the labial, where tied in the operation. 

i. Plexus of arteries formed by inosculations of the ascending thyroid and 

a descending branch of the occipital. 
h. Descending branch of the occipital. 
I. External carotid. 



Peirce's Case of Cancer, 49 

PLATE II. 

This plate will give some idea of the success which attended the 
injection of the left side of the head and neck. Most of the more 
considerable vessels are here delineated, but the beauty of the pre- 
paration far surpasses the plate in the minuteness with which the 
vessels are filled. All these are preternatu rally enlarged. Only a 
few of the arteries which are most enlarged, will be referred to in 
the explanation of this plate. There is no variety in the course or 
distribution of the arteries. 

Fig*. 1. The two portions of the sterno-cleido mastoideus muscle. 

2. Left carotid as large as the innominata.* 

3. Left subclavian artery external to the scaleni muscles, 

4. Superior thyroid artery. 

5. Labial artery much enlarged. 

6. Mental artery twice its common size. 

7. Par vagum raised up, and seen crossing the carotid artery, 

8. Arch of the aorta. 

New York, Oct 10th, 1830. 



Art. III. Case of Cancer cured by repeated Excisions and a Diet of 
Indian Corn, Zea mays, Linn. By Leonard Peirce, M. D» of 
Sutton, Mass. 

1 HE pathology and treatment of cancer are still involved in much 
uncertainty. The investigation of its causes with the best mode of 
treatment has for a long period of time employed some of the ablest 
minds of which the profession can boast. But notwithstanding the 
numerous explanations which have been given of its causes, and the 
still more numerous methods of cure, embracing nearly every va- 
riety from the most simple and cautious to the most complicated, the 
disease is still where it was centuries ago, in the first rank of the 
most formidable and terrifying of human maladies. Its bare name is 
associated with almost certain deaths at the first intimation of its ap- 
proach, life recoils with a wish that it had never been called into be- 
ing; and on its actual existence, fortitude itself vanishes and leaves, 
the mind a prey to the most gloomy anticipations. Whoever shall be 
so fortunate as to point out a method of treatment which will ordina- 
rily prove successful, may rest satisfied, that without any other mo- 
nument, his name will be remembered with gratitude in all enlight- 
ened countries, so long as cancer shall continue to afflict his fellow 



50 Pelrce's Case of Cancer. 

creatures. However unsuccessful the efforts of surgeons may have 
been, it is still their duty never to relax their labours so long as a 
chance remains for improvement. 

In offering a history of the following case to the profession, I shall 
not perhaps present any thing entirely new, yet I believe some por- 
tion of the treatment is different from any which has ever been re- 
commended by writers on the subject, and from the entire success 
which seems to have attended it, is entitled to a respectful consider- 
ation. But should I fail of presenting any thing new, and offer no- 
thing but the details of an ordinary case, I shall readily be pardoned 
for the interest I may manifest in its relation from the subject of it 
being my mother. Sufficient time has elapsed since the last operation 
to inspire considerable confidence in the success of this course of 
treatment, and should it be adopted by others, it is hoped the result 
will be made public. 

The disease was in the right breast. She first discovered a tumour 
about the size of a chestnut, in September, 1825, at which time she 
was in her sixty-second year. On the following March she consulted 
me, and I recommended its removal, but on the recommendation of 
Dr Smith, of this town, concluded first to try the effects of iodine. 
I commenced with fifteen drops of the tincture of iodine three times a 
day, in a little molasses and water, and gradually increased the dose 
to eleven drops. At the same time the iodine ointment was applied 
to the whole breast two or three times a day. This treatment was 
continued for several weeks, and the tumour continued to grow, at- 
tended with lancinating pains in the breast and axilla, and it was 
thought by Drs. Greene and Heywood, of Worcester, and Dr. 
Smith, of this town, that its removal should be delayed no longer. 
It was removed on the 29th of May, 1826, by Dr. John Greene, assisted 
by Drs. Heywood, Smith, and myself. The patient sat in a chair with 
the arms carried back by an assistant, but otherwise remained at li- 
berty during the whole operation, which she bore with remarkable 
fortitude. The head rested upon a pillow supported by myself. Two 
incisions were made in the direction of the axilla and sternum, in- 
cluding sufficient width of skin to make a level surface after the 
gland was removed, the whole of which was taken away, together 
with a part of the facia covering the pectoral muscle. The lips of 
the wound were drawn together with adhesive straps and dressed 
with simple cerate. This wound healed without any difficulty, and 
in the usual time. 

After recovery from this operation, her health remained as good as 
usual, until the winter of 1826 and 7, when another tumour appear- 



F 'eir ce's Case of Cancer. 51 

ed just beneath the cicatrix, attended with pains darting into the ax- 
illa, as in the first tumour. Similar pains were now felt in the neck 
of the uterus. No medical treatment was now adopted, and the only 
reliance was upon the scalpel. It was removed on the 5th of April 5 
1827V by Dr. Smith, assisted by myself. A simple incision was 
made, the tumour not being more than an inch in diameter. The 
wound was dressed with adhesive straps and cerate as before, and 
the dressings renewed every day. It showed but little disposition to 
heal, and luxuriant granulations shot up from every part of it, and 
a very little purulent matter was discharged. Within a few weeks 
from the removal of the last tumour, two others appeared in the 
neighbourhood of the wound, increased rapidly, soon ulcerated, unit- 
ed with the granulations, and formed a hemispherical tumour, which 
was slightly elevated above the surrounding skin, and seemed to rest 
on a partial peduncle. The centre of the tumour appeared to increase 
faster than the borders, which were thus made tense and turned in 
towards the peduncle. The whole surface of the tumour had an ex- 
ceedingly jagged and angry appearance. It would bleed on the 
slightest injury, and often without any hurt whatever. The discharge 
was not now at all purulent, but watery, giving to the dressings a 
very slight tinge of yellow and rendering them a very little stiff when 
dry. Whenever this discharge came in contact with the sound skin, 
it produced an intense smarting, and unless immediately wiped off 
would excoriate. If the dressings were suffered to remain after they 
became wet with the discharges, the pain was increased to an insuf- 
ferable degree, and she was obliged to change them every ten or fif- 
teen minutes during the whole time. The pain in the tumour and 
axilla had now become exceedingly severe and almost uninterrupted^ 
it was severe but less constant in the neck of the uterus. Death now 
seemed to be the inevitable consequence of the disease. All the ap- 
pearances were more unfavourable than heretofore, and she declined 
having it removed again, from a belief that it would be attended with 
no better result than before, and that it would only add to her suf- 
ferings, which must soon terminate her life. I now wrote to Profes- 
sor Smith, of Yale College, whose pupil I had been, giving him a 
history of the case, with the treatment which had been pursued, re- 
questing his opinion of the case. He replied as follows:— 

"New Haven, Aug. 11, 1827. 
" Dear Sir, — Yours of the 1st inst. has been received. Respecting- your mo- 
ther's case, I would advise to remove all the tumour at once. I once removed 
a cancerous breast which weighed seven and a half pounds. Several tumours 



52 Peirce's Case of Cancer, 

arose afterwards in the neighbourhood of the cicatrix, which were removed, 
and the woman is now living- and well. 

"After removing the tumours, I would put her upon a vegetable diet, and 
not allow her to taste animal food for a year at least. I should like to have her 
live some time on green corn and water. She may boil it or roast it as she likes 
it best, or she may cut it off the cob and boil it in water and season it with salt 
and eat it in that way. If you cut it from the cob do it as follows. Take the ear 
fresh picked, and having a pan of cold water, put the end of the ear on the 
bottom of the pan, and with a knife cut off the corn and let it fall into the wa- 
ter. Scrape the cob with the knife and plunge it in the water, and wash out 
all the milk that adheres to it. I have found that a diet of Indian corn is very fa- 
vourable to cancerous patients. 

"I would give the following medicine:— R. Red oxide of iron, ^iss. ; Ext. 
conium, ^ss.; simp, syrup, q. s. — Mix and make twelve pills to a drachm. Dose 
to commence with three pills morning, noon, and night, and increase the dose 
to as large a quantity as she can bear on account of the conium. * * * * 
"I am, with sentiments of esteem, your friend, &c. 

"NATHAN SMITH. 
" Leonard Peirce, M. D." 

She would not yet consent to the removal of the tumour, but com- 
menced immediately with the diet, which she most rigidly adhered 
to. The corn was prepared by cutting it from the cob and boiling it 
as directed. She used the oxide of iron and conium in as large 
quantities as she could bear. 

Drs. Green and Smith were now called, who united with the opi- 
nion of Professor Smith in recommending its removal, to which she 
finally consented, more however in deference to the opinions of her 
advisers, than from a belief that it would arrest the disease. She 
now had an attack of the dysentery, from which she did not recover 
for two or three weeks. During the acute stage of this disease the 
discharge from the cancer considerably abated, but was not other- 
wise affected. On the 13th of September she had so far recovered as 
to be able to submit to the operation. At this time the tumour was 
larger than the breast, whose place it occupied, and it had for more 
than two months bled from one to three ounces daily. The skin 
around the base or peduncle, which was now nearly four inches in 
diameter, was so diseased as to require its removal to the distance 
of nearly an inch on each side of it. Her health was very feeble from 
previous suffering, and much doubt was entertained of her surviving 
the operation. She was seated in a chair as at first, and supported 
but not confined by assistants as before. Dr. Greene operated, as- 
sisted by Drs. Heywood, Smith, and myself. Two incisions were 
made, meeting at the sternum and axilla. The tumour was cautious- 



Peirce's Case of Cancer. 53 

ly and with much dexterity dissected from the pectoral muscle which 
appeared to be perfectly sound and healthy. It was thought that 
could the lips of the wound be brought together, it would be more 
likely to heal than it would if a large surface was left uncovered by 
skin. By considerable effort the lips were brought together, and con- 
fined by the interrupted suture and adhesive straps. This put the 
skin so violently upon the stretch, that her head, neck, and shoul- 
ders were drawn obliquely forwards and downwards, which occasion- 
ed for a time severe pain. The operation was performed about three 
o'clock in the afternoon, and notwithstanding the force used in the 
dressing, she passed the succeeding night more comfortably than she 
had any night for six weeks before. 

Nothing unfavourable took place to interrupt the healing of this 
wound, except some slight granulations shooting upon its edges, which 
were reduced by the daily application of nitrate of silver. It soon 
entirely healed, and formed a round cicatrix, and the pains in the 
axilla and uterus had entirely subsided. She had up to this time most 
rigidly adhered to her prescribed diet, eating nothing but boiled corn 
seasoned with salt, and drinking nothing but simple and cool drinks. 
The pills were omitted after the operation. She was fully convinced 
that she was deriving essential benefit from her diet, and notwith- 
standing the severe self-denial it imposed upon her, most cheerfully 
submitted and clung to it as her only hope. 

When corn was in a fit state to boil, she had a large quantity of it 
gathered, boiled, dried in the sun, and laid up for future use. Pre- 
pared in this way it would not receive injury by keeping, and re- 
tained the flavour of corn fresh picked. On this she subsisted till the 
next season for green corn returned, when she supplied herself again 
from the field, and continued its use during the season for it. She 
then began the use of boiled ripe corn, sometimes boiling it as it 
came from the cob; at others having it cracked in the mill, and made 
into homony, which she eat with molasses. She frequently eat, in- 
stead of the corn, bread made of Indian meal, mixed with water, and 
baked by the fire. 

She now attempted the use of animal food, by barely tasting it, 
but was obliged to abandon it at once, as it produced pains in the 
axilla, similar to those she had felt in the cancer. It likewise made 
her mouth and throat sore. The attempt was several times renewed 
at intervals of several months, but always with similar results. 
Roasted potatoes agree with her well. She occasionally eats fish 
sparingly. She continues her diet to this time, and most studiously 

No. XV.— May, 1831. 6 



54 Peirce's Case of Cancer. 

avoids all kinds of animal food, all kinds of distilled or fermented 
liquors, spices of every kind, and all hot and heating drinks. Exercise 
and mental emotions, for a considerable time after the last operation, 
produced effects similar to those of animal food, and she most se- 
dulously avoided them. She has never deprived herself the use of 
tea, but always takes it cool, and in limited quantities. From the 
time she began to diet, the alvine discharges were thin and watery, 
and continued so long as she confined herself to green corn. They 
were likewise, for a considerable time, hot and excoriating. Within 
a few months from the last operation, she was able to sit erect, and 
had a tolerably free use of her right arm, and its motions are now 
entirely free. During the time she confined herself to green corn, 
her strength was so feeble that she was unable to perform any manual 
labour, but took the general superintendence of her household affairs. 
After she began the use of ripe corn, and eat bread and other vege- 
tables, her strength increased so mUch that she was able to do some 
light work. At present, her health is as good as before she was 
afflicted with cancer, and she has become so accustomed to her diet 
that she enjoys it as well as she would a more generous one. 

There have been other cases of cancer in which two or three ope- 
rations have been performed, and the disease subdued. But from 
the obstinacy of the disease in this case; its increased violence after 
the second operation; and from a total inability to resume her former 
diet, the conclusion seems to be, that without the diet she would never 
have recovered. Had the diet been commenced immediately after the 
first operation, I have no doubt but the result would have been equally 
favourable, and have prevented a vast deal of suffering. Covering 
the wound with the skin, by drawing the edges together, was un- 
doubtedly a wise precaution against the growth of morbid granula- 
tions, and I think should not be neglected in similar cases. It may 
seem impracticable to those who have not made the experiment, to 
close an opening of six or seven inches in width, where the skin is 
no more yielding than it is about the upper part of the chest, and on 
the side, and abdomen; but by a little bending of the body, with 
some inclination of the head and shoulder, it may be accomplished 
without difficulty, and the fain it occasions is but transient. It was 
done, I believe, at the suggestion ofr^Dr. Greene. The adhesive 
straps used in the dressings, were the wove ones, which are much 
the best for wounds of this description, as they permit the discharge 
of pus, &c. and the renewal of the dressings of cerate without being 
removed. 



Mitchell. on a New Practice in Rheumatism, 



55 



The accompanying drawing re- 
presents this strap. It consists of 
four pieces of muslin, united by 
threads, which interlace in the 
way shown in the drawing. The 
figure is about one-fourth the ne- 
cessary size for the straps. This 
strap is used by spreading the 
under side of each part of it with 
plaster, then place the two under 
ones upon the sound skin, so that the ends to which the threads, are 
attached may be about three lines from the edges of the wound; then 
draw the upper ones until the edges of the wound come together, 
when they are to be pressed down upon the under ones, and this 
confines the whole. 

Sutton, Mass. March, 1831. 




Art. IV. On a New Practice in Acute and Chronic Rheumatism. By 
J. K. Mitchell, M. D. one of the attending Physicians of the 
Pennsylvania Hospital. 

IN the autumn of 1827, a patient affected with caries of the spine, 
was suddenly attacked with all the usual symptoms of acute rheuma- 
tism of the lower extremities. One ankle, and the knee of the oppo- 
site leg tumefied, red, hot, and painful, afforded as fair a specimen 
of that disease in its acute stage as is usually met with. The usual 
treatment by leeches, purgatives, and cooling diaphoretics, with 
evaporating lotions, had the effect of transferring the symptoms to 
the other ankle and knee, and finally to the hip. Disappointed in 
the treatment, I began to suspect that the cause of the irritation 
might lie in the affected spine. The difficulty of cure, the transfer 
of irritation from one part of the lower extremities to another, with- 
out any sensible diminution of disease, and the fact of the existence 
of caries in the lumbar vertebrae, which lie near the origin of the 
nerves of the lower extremities, rendered probable the opinion, that 
in the spinal marrow lay the cause of this apparently indomitable and 
migratory inflammation. Under this impression, I caused leeches to 
be applied to the lumbar curve, and followed them by a blister, 
placed on the same spot. Relief promptly followed these remedies, 
and the pain ceasing to be felt in the limbs, was perceived only in 



56 Mitchell on a New Practice in Rheumatism. 

the immediate vicinity of the spinal curve. After the blistered sur- 
face recovered its cuticle, a few leeches placed over the diseased 
spine removed the pain, and left the patient in the usual state of in- 
different health attendant on such forms of spinal disease. 

Striking as were the benefits of the applications made to the spine 
in a case of apparent inflammatory rheumatism, they did not lead 
my mind at the time, to the general conclusions which, viewing the 
case as I now do, they ought to have suggested. 

In the beginning of the ensuing winter, another case of a similar 
kind presented itself. A little female patient, having curvature of 
the cervical vertebrae, was attacked in the night with severe pain in 
the wrist, attended with redness, tumefaction, and heat. As on the 
appearance of these symptoms, the pain in the neck, to which she was 
accustomed, subsided, I easily persuaded myself of the spinal origin 
of this inflammation, and accordingly applied leeches to the cervical 
spine, with the effect of procuring a prompt solution of the disease 
of the wrist. 

This case led me very naturally to the reflection that, perhaps 
other cases of rheumatism might have an origination in the medulla 
spinalis, and depend on an irritation of that important organ. In the 
following spring an opportunity of testing by practice the truth of this 
opinion presented itself. William Curran, a respectable livery stable 
keeper in Marshall's Court, had been for upwards of two years af- 
flicted with a rheumatism of the lower extremities, which gradually 
deprived him of the use of his limbs, and finally confined him to his 
chamber. Regular medical aid, and many empirical remedies had 
been procured, without an abatement of the pain, which became at 
length almost intolerable. 

On my first visit I found him in his room, in a paroxysm of pain. 
His legs were swollen from knee to ankle, and the enlargement of 
the periosteum and integuments, gave to the anterior face of the 
tibia an unnatural prominence. In that place the pain and tender- 
ness on pressure, were particularly developed. He was also suffer- 
ing severely from pain in the scalp, which had existed for a short 
time previously, and was at length almost insupportable. Along 
with these symptoms appeared the usual febrile action with its con- 
comitants. ■ 

Notwithstanding the significant hints given by the spine-cases 
referred to, I treated this case for a time in the usual manner — de- 
pleted freely, purged actively, blistered the head, and having caused 
an abatement of fever, administered corrosive sublimate and decoc- 
tion of sarsaparilla. Defeated in all. my efforts, I at length suggested 



Mitchell on a New Practice in Rheumatism. 57 

i to my patient the possibility that his disease was so unmanageable be- 
cause we had not applied our remedies to the true seat of disease, and 
that by addressing our measures to the spine, success might yet be 
found. Accordingly, on the l§th of February, 1828, nine days 
after my first visit, I had him cupped at the hack of the neck, and as 
he could not bear any more direct depletion, inserted a large seton 
over the lumbar spinal region. The cupping, followed by blisters 
to the back of the neck, relieved his head, and as soon as the 
seton began to suppurate freely, his legs became more comfort- 
able. From the 25th, nine days after the insertion of the seton, I 
visited him but seldom, although I had seen him once or twice a 
day until that period. Indeed, I paid him but seven visits after the 
25th. The last was on the SOth of March. Soon afterwards he 
resumed his usual pursuits, and about the beginning of June the seton 
was removed. Since that time he has not had a return of his com- 
plaint, and is at the date of this paper, in the full and vigorous exer- 
cise of all his physical faculties. 

I could scarcely doubt as to the cause of the cure in this case, be- 
cause the treatment applied to the spine was that alone which had 
not already been fully and fairly tried, either by me or those who had 
preceded me. Indeed, the last applications were made with some 
hope of success, and the grounds of that hope were expressed to the 
patient, w 7 ho was fully persuaded that the spinal treatment was the 
chief, if not the sole agent of restoration. 

No other well-marked case of rheumatism presented itself in my 
private circle of practice, until in the winter of 1830 Mr. Teale's 
work on neuralgic diseases reached this country and began to at- 
tract towards the spinal marrow a greater share of medical atten- 
tion. Although in his essay, I found nothing directly calculated to 
sustain me in the opinion I felt disposed to adopt concerning the spinal 
origin of rheumatism, I rose from its perusal with increased confi- 
dence in that opinion, and resolved to experimentally examine its 
truth. The first well-marked case of simple inflammatory rheuma- 
tism which subsequently presented itself, was the following: 

Robert Gordon, well-known as the carrier of Poulson's Daily Ad- 
vertiser, fifty-six years of age, of vigorous constitution and active 
habits, was the subject of the attack. Observing a severe pain in his 
right heel and ankle, immediately followed by redness, heat and tu- 
mefaction, he caused himself to be largely bled and took some salts 
and magnesia. On the following day the pain and swelling increased, 
and the ankle and knee of the opposite limb becoming similarly 
affected, he was confined to bed. 

6* 



58 Mitchell on a New Practice in Rheumatism. 

On the 3d day my first visit was made. The patient had then a 
full, strong, frequent pulse, flushed face, dry skin, whitened tongue, 
and complained much of the severity of the pain in his legs, and of 
his incapacity of enduring the slightest pressure or motion. As he 
had already been purged and had used a lotion, I. directed the ap- 
plication of seventeen cups to the lumbar region, so as to abstract 
twelve or sixteen ounces of blood. 

Next morning found the pain almost entirely gone, does not com- 
plain of moderate pressure, and is able to move his legs without in- 
convenience. Ordered a draught of salts and magnesia, with an 
evaporating lotion of camphor in alcohol. 

3d day, pain in legs scarcely perceptible, but the shoulders, el- 
bows and wrists, are beginning to exhibit marks of severe inflamma- 
tion, expressed by pain, , tumefaction, heat and redness. Ordered 
twelve cups to the cervical spine. 

4th day. The patient sits up, complains of stiffness, but no pain 
except in one wrist, and that very slight. Directed Epsom salt and 
magnesia. 

5th day. Finding nothing for which to prescribe, arranged the 
patient's diet, recommended the occasional use of aperients, and 
took leave of the case. 

Called on the 10th to enquire into results, and found that there 
had been no return of disease. 

Since that time a very severe winter has passed, during which 
the subject of this report has continued in his customary health, and 
in the pursuit of his usual employments. 

The reader will, in the above case perceive, that the general bleed- 
ing, though very copious, proved of no service, and that the large 
local depletion of the lumbar region, benefited solely that part of the 
disease which lay at the peripheral extremities of the nerves, sup- 
plied by the lower end of the spinal marrow. The inflammation in 
the upper extremities continued afterwards in progress, and was ar- 
rested only when cups were placed over the cervical end of the 
spinal column. 

The whole case exhibits a fine exemplification of the difference in 
the character and extent of the influence of general and topical de- 
pletion, and proves that local blood-letting is most potent when ap- 
plied to that part of the spine, which supplies with nerves the parts 
in a state of active inflammation. 

As I feel, in common with the profession, a greater confidence in 
Hospital reports, especially when made by those who are not by in- 
terest or reputation blinded or misled, I shall present the history of 



Mitchell on a New Practice in Rheumatism. 59 

some cases treated after the new method, as drawn up at my request, 
by Dr. Stewardson and Dr. Norris, the resident physicians of the 
Pennsylvania Hospital. 

The following case, reported by Dr. Thomas Stewardson, is pe- 
culiarly interesting, because of its evident dependence on irritation 
of nervous masses, and the immediate and perfect remedial action of 
the local applications. 

Case I. — William Anderson, coloured man, a seaman, aged fifty, 
was admitted into the Pennsylvania Hospital on the 31 st o£ Decem- 
ber, for a chronic rheumatism of upwards of five years duration. 
Occasionally the disease intermitted, but generally continued to af- 
fect him during the cold season. The pain affected at one or at 
various times, almost every part of his right side from head to heel, 
but had in no case at any period, crossed to the opposite side. Like 
other cases of chronic rheumatism, it was most severe in cold 
weather, and when warm in bed. According to his statement he 
seldom suffered from a winter attack for a less period than three or 
four months, and the existing exacerbation had lasted only a few 
weeks. 

On the 2d of January, two days after his admission, eight cups 
were applied to the back of the neck and left side of the head, and 
a powder was taken, consisting of guaiacum and nitrate of potassa, of 
each ten grains, with directions to repeat it three times a day. 

On the 3d, "pain in the head and arm completely gone — leg no 
better." 

On the 4th as on the 3d — A blister to the nape of the neck, and 
eight cups over the lumbar spine. 

On the 5th. — " Says the cups almost immediately relieved the 
pain in his leg. He now feels perfectly well. " 

On account of the extreme rigour of the season, the patient was 
not discharged until the latter part of February, during which period 
he remained entirely free from disease. 

Case II. — Jane Black, aged sixteen, was admitted into the Hos- 
pital on the 9th of March, 1831. About four weeks antecedently, 
she perceived pain, tumefaction, and a sense of numbness in her 
feet and ankles, which gradually deprived her of locomotion; and on 
the third or fourth day, confined her to bed. On the second day 
after the attack, her wrists and hands were similarly affected. In 
the course of a week her wrists, fingers and ankles, became flexed 
and rigid, feeling pain from every attempt to straighten them. Such 



60 Mitchell on a New Practice in Rheumatism, 

was her condition when admitted. She states that she is of a costive 
habit, and had been amenorrhagic for two or three months before the 
appearance of rheumatism. The previous treatment consisted, as 
she said, of a blister to the umbilical region, and some powders and 
drops. On her admission, Dr. Norris applied six cups to the cer- 
vical, and six to the lumbar spine, which " took away entirely the 
pain" 

On the following day Dr. Otto saw her, and recommended a 
continuance of the treatment, and accordingly four cups were ap- 
plied to the upper, and four to the lower part of the spine, with the 
effect ot enabling her to extend her wrists, and to grasp, though 
imperfectly, with her hands. 

On the 11th took Epsom salt. 

On the 13th spine cupped as before, and a dose of magnesia di- 
rected. After the cupping to-day, she begins to observe a "prick- 
ing sensation, as if her feet and hands were asleep." 

On the 16th, cups as before. 

On the 18//*, find her free from pain and tumefaction, recovering 
gradually the use of her hands, experiencing no uneasiness on mo- 
tion or pressure. She is unable to stand, because her feet " slide 
from under her;" but the attempt gives no pain. Besides the reme- 
dies already mentioned, soap liniment was applied twice a-day to 
her wrists and ankles. 

Remarks. — In this highly interesting case, the complication of 
rheumatic irritation with numbness, and enfeebled condition of the 
extensors of the hand, and the congeneric flexors of the foot, amount- 
ing almost to paralysis, emphatically directs us to the centrally ner- 
vous origin of this disease. 

Case III. — " William White, seaman, aged fifty-two, was ad- 
mitted November 27th, for rheumatism. He stated that he had an 
attack in the preceding winter, which had confined him to bed for 
five months, and that the present affection had commenced with 
equal severity. On admission, his wrists and arms were tumid and 
painful, and he complained also of pain in the lumbar region and 
lower extremities. Cups were applied to his spine, and repeated at 
proper intervals, two or three times, without the use of any auxiliary 
remedies. The relief was almost complete, when in consequence of 
some accident, he was affected with fever and pain in the head, for 
which he was cupped and blistered at the nape of the neck, and a 
saline purgative given. Being relieved from the cephalic irritation, 
he began in a few days to complain again of pain in the feet and 



Mitchell on a New Practice in Rheumatism. 61 

ankles, which appeared hot and tumid. Cups having been applied 
to the base of the spine, entire exemption from pain ensued. The 
severity of the season prevented his discharge until the %6th of Feb- 
ruary; but for more than. a month before, he had ceased to feel any 
other inconvenience, than a very slight soreness on the top of his 
feet, and that only when walking. That pain left him previous to 
his discharge." This case is reported by Dr. Stewardson. 

Case IV.— " William King, a seaman, was admitted for a surgi- 
cal disease, for which he used venesection and low diet, followed by 
balsam of copaiba and cubebs. 

" On the 24th, he was seized with severe rheumatic pain in his 
left side and shoulder. For this he was twice bled largely, and put 
under the use of sarsaparilla and nitrous powders, and afterwards of 
Dover's powders. A stimulant liniment was also applied to the 
affected part. Under this treatment he remained until the 6th of 
February, when the pain appeared to be fixed in both the side and 
shoulder, and he had not been benefited in any way by the reme- 
dies employed. 

"On the 7th of February, all other remedies being discarded, 
twelve cups were applied to the spine. 

" &th, pain relieved. Cups to be reapplied. 

" 11th, patient states that the last cupping has almost entirely re- 
moved the pain from his shoulder, but has not benefited that of his 
side. Ordered eight cups to dorsal spine. 

" 13th, no change after last cupping. Cups to be again applied. 

" 16th, the pain in the shoulder left the patient soon after the ap- 
plication of the cups on the 15th, and has not returned. 

"As the pain in the side was confined at last to a small surface, 
and had been constant for some time, a few cups were applied imme- 
diately over it, with beneficial effect. Their repetition at length 
entirely removed it. " This case is reported by Dr. G. Norris. 

Remarks. — The practical interest of this case consists in the total 
failure of the most judiciously selected remedies of the current prac- 
tice, and the facility with which the disease, so obstinate before, be- 
gan to yield to the very first application of cups. To those who 
still maintain the identity of the effect of general and topical deple- 
tion, this case presents a striking difficulty. 

Case V.*— " William Brown, seaman, was admitted March 5th, 
1831, for rheumatism. Three months ago he was exposed at sea to 
great hardships in an open boat. On the day after he was picked up, 



62 Mitchell on a New Practice in Rheumatism. 

he felt pain in his shoulders and elbows, which remained until after 
his arrival in port, and then suddenly attacked his lower extremities, 
while entire exemption from pain was experienced in his upper ones. 
On admission, he complained of pain in the whole course of his legs, 
but finds it particularly severe in his knees and ankles. The right 
ankle is swollen, hot, and very painful. Directed the application of 
ten cups to the small of the back. 

" March 6th. Is no better. — On examination, I found that the 
cups had not been placed on the part as ordered, but had been extend- 
ed to the top of the spine. Therefore ordered another cupping to 
the loins. 

" 7th. Was relieved by the cups for a time, but the pain has 
returned. Cups to be repeated. 

" 8th. Has had very little pain since the last scarification. The 
tumefaction of the right ankle has disappeared, and the heat and 
pain have entirely gone from it. 

" On the 11 th and 13/A, in consequence of the reappearance of 
slight symptoms of the disease, cups were ordered. Their applica- 
tion in both instances afforded relief." Reported by Dr. G. Norris. 

Remarks. — In the case just recited, the attention of the reader is 
called to the fact, that the cups produced no relief whatever when 
applied over that part of the spine which did not transmit nerves to 
the seat of inflammation, thus verifying the important doctrine, that 
the most potent influence is exerted, when our depletory remedies 
are addressed as nearly as possible to the disease exciting agent. 

Case VI. — u Thomas Gordon, a man of colour, a seaman, aged 
thirty -four, was admitted on the 15th of February, for rheumatic 
fever. The pain is confined chiefly to his limbs, and his pulse, al- 
though excited, is not very active. Ordered ten cups to spine. 

"17th. No improvement. It is discovered that the cups had 
not been placed near the spine, but at a considerable distance on 
each side of it. Ordered ten cups to dorsal spine. 

" 18th. The pain in his body and arms diminished, but no im- 
provement observable in his lower extremities, in consequence of 
which eight cups were applied to the lumbar portion of the spine. 
For a slight cough, some mucilage was ordered. The patient was 
relieved by the last cupping, and the pain almost entirely left him. 
For stiffness in his legs, a stimulant liniment was finally directed. 

" On the 1st of March, having been previously apparently cured, his 
disease suddenly returned. As he had along with other symptoms 
of fever, a strong and frequent pulse, sixteen ounces of blood were 



Mitchell on a New Practice in Rheumatism. 63 

abstracted, and nitrous powders administered — but as on the follow- 
ing day, no abatement of the pain of the lower extremities appeared, 
and though the fever was reduced, eight cups were applied to the lum- 
bar spinal region, which entirely relieved him. 

44 On the 9th of March, he was discharged cured. After the last 
scarification, he used for stiffness and weakness of his joints, 1 a 
stimulating liniment." — Reported by Dr. Stewardson. 

Remarks.-^ln this case several facts are worthy of notice. Twice 
the cups failed to relieve the lower extremities, once because they 
were not applied to any part of the spine, and once because they 
were placed on the dorsal region. The very first application to the 
lumbar region afforded the expected benefit. In the relapse, a large 
bleeding and nitrous powders sustained a total failure, while a very 
moderate quantity of blood drawn from the lumbar region by cups ? 
produced an immediate and final solution of the disease* 

Case VII. — " William Richardson, a seaman, was admitted, or 
the 11th of February, for rheumatism. His attack commenced two 
weeks before, with pain in the dorsal region and occiput, followed 
by a sense of numbness, with pain in almost every part of his body, 
On admission his skin felt cold, his pulse was frequent, tongue 
slightly coated, and his bowels regular. 

44 12th of February. Twelve cups were applied along the spine» 

" 13th. Has no pain; slight numbness of the legs; no appetites 
slightly vertiginous; directed him an ounce of sulphate of magnesia. 

44 14th. Nausea, for which ordered effervescing draught. For the 
numbness, directed soap liniment. 

44 15th. No improvement; the numbness of his hands being espe- 
cially disagreeable, a few cups were applied to the nape of the 
neck. 

64 17th. Find the patient free from pain and numbness. 

44 For an enlargement of the spleen this patient remains in the hos- 
pital, but has not had any relapse." — Reported by Dr. Stewardson, 

Remarks. — The most remarkable feature in this case is the con- 
comitant numbness, and the greater difficulty of removing that than 
the pain, a fact which is not unfrequently observed in cases of rheu- 
matism. The vertiginous affection too, is interesting as significant 
of the irritation of central nervous masses. 

Case VIII.^- 44 Rebecca Leshler, affected by rheumatism of two 
weeks duration, exhibited a swollen arm and shoulder, attended with 
pain and redness. She could elevate her arm only when firmly 



64 Hosack on the Actual Cautery. 

grasped by the hand of an assistant, when the motion became com- 
paratively easy. 

"In the evening of the 5th of March, ten cups were applied so as 
to extend from the top of the neck downwards, immediately over the 
spine. On the following morning, the pain was gone, and on the 
subsequent day every vestige of redness and swelling disappeared. 
No other treatment was used." — Reported by Dr. Stewardson. 

Although other cases might be cited in confirmation of the views 
here taken, I have not leisure at this time to digest and arrange them. 
At no very distant period I hope to be able to bring the subject more 
fully before the profession. I may observe in general, that, as far as 
I now recollect, only two cases of apparent rheumatism, have in my 
hands, either in private practice, or in the Pennsylvania Hospital, re- 
sisted the treatment recommended in this paper, and both of them 
were in reality neuralgia, and exhibited no traces of inflammation. 
One of them was an affection severely painful, located in the bottom 
of the heel, the other was gastric and intercostal. 

The preference given to local depletion over other local measures, 
arose from the greater apparent success and promptness of its action, 
which scarcely left any thing to be desired: but cases will occur in 
which other measures must be used, and in which, perhaps, all mea- 
sures will fail. We are warranted, however, in declaring our con- 
viction, that few failures will happen in thus treating acute rheuma- 
tism, and that success will diminish, as passing through chronic rheu- 
matism, we enter on the ground of neuralgia, sl disease which some- 
times spontaneously disappears; but is scarcely ever, in this city, 
cured by merely medical means. The art of the surgeon occasionally 
subdues it, and the physician often allays, but seldom removes it. Be- 
ing paroxysmal, and often slumbering for weeks or months, it is not un- 
frequently mastered in appearance, though seldom cured in reality. 



Art. V. Observations on the Use and Advantages of the Actual Cau- 
tery, with Cases. By Alexander E. Hosack, M. D. (Read before 
the Medical and Philosophical Society of New York, Jan. 1831. 

IN the present communication, I beg leave to offer to the Society, 
a few observations upon the use and advantages of the actual cau- 
tery, and to enumerate the circumstances under which it seems to 
possess claims superior to those of any other remedial application. 



Hosack on the Actual Cautery. 65 

It appears to have been in use from an early age, and travellers in 
Africa relate that it is still principally depended upon by the Arabs 
of the Great Desert, in the inflammations of the brain to which they 
are so liable. Among surgeons it has varied in estimation, like every 
other remedy, but has of late been much employed in Europe, and 
has almost entirely superseded the use of the chemical caustics, hav- 
ing been found to act with more certainty, and in a shorter space of 
time; often indeed has it evidently arrested the progress of the most 
formidable disease. 

It has been used for the destruction of diseased or poisoned parts 
— for producing a salutary irritation where the tone of the part 
has been too much lowered — as a counter-irritant for the transfer of 
inflammation — as a means of arresting haemorrhages, in which, how- 
ever, I must confess, that my own experience has not confirmed the 
statements of others. 

The particular cases in which I have seen it attended with the great- 
est advantages, have been, in the prevention of hydrophobia and the 
destruction of fungous growth — in old and atonic ulcers, necrosis, 
caries, hospital gangrene, and cancer — in imparting vigour to the in- 
teguments surrounding enlarged joints — as a counter-irritant in ca- 
talepsy, epilepsy, inflammations of the brain, &c. 
There are two means of cauterization — 

First, the hot iron, which should always be brought to a white 
heat, and applied immediately when taken from the fire.* The de- 
sired effect is then produced with more certainty, and infinitely less 
pain. We are in no instance to suppose that the degree of irritation 
produced will be only in proportion to the heat of the instrument; it 
will depend entirely upon the time employed in the application, 
which should be regulated accordingly. In some cases, as of chronic 
enlargement of the joints, where the source of diseased action is far 
from the surface, and concentrated within the articulation itself, it 
is necessary to make incisions through the skin and subjacent cellu- 
lar structure, previous to the employment of the cautery; it will thus 
sometimes happen, that the heat imparted will invite a flow of blood 
to the wound, and thereby cool the instrument; in order that the ob- 
ject of the application be not thus defeated, several others should be 
kept hot, and applied in succession if required. 

Secondly, by the moxa, which can however serve only as a coun- 

* A small portable furnace, or large chafing-dish, with charcoal, which may 
be brought to the bed-side of the patient, offer the most convenient means for 
this purpose. 

No. XV.— May, 1831, 7 



66 Hosack on the Jlctual Cautery. 

ter-irritant A detail of the minutiae necessary to be observed in 
either application, would employ too much space, so I must refer the 
reader to the Memoires de Chirurgie of Baron Larrey, where they 
may be found. 

In wounds inflicted by rabid animals or poisoned instruments* the 
actual cautery seems to me absolutely indispensable, and during my 
residence in Paris, I repeatedly witnessed its successful application 
as a preventive. Eleven persons bitten by dogs affected with hydro- 
phobia were admitted into the hospitals of the Hotel Dieu and Cha- 
ritej the wounds were generally very slight* scarcely more than 
punctures which are of all others to be dreaded. Immediately on their 
arrival the wounds were seared and the discharge kept up by irrita- 
tive ointments. Three of the number died in agony, with all the hor- 
rors of hydrophobia, the others were not attacked to my knowledge 
— a proportion less fatal than that from any other report I have yet 
seen* 

The bite of a poisonous serpent, like the rattlesnake, is gene- 
rally so instantaneous in its effect, that there is less hope of suc- 
cess from any local treatment, yet excision followed by cauterization 
should always be resorted to. On the other hand, the symptoms of 
hydrophobia frequently do not become manifest for months after the 
infliction and even the healing of the wound. Whether the poison 
still lurks in the vicinity of the cicatrix, or requires time for its elabo- 
ration in the system, we know not. The continental surgeons, how- 
ever, recommend cauterization, in all cases where danger may be 
apprehended, considering the pain inflicted as more than recompens- 
ed by the additional security afforded against a disease so dreadful 
and hitherto incurable. The injured part should be freely laid open 5 
and the iron applied until the irritation shall have extended for 
some distance around. The wound thus produced should be dressed 
from the bottom, and kept in a state of suppuration for a length of 
time by digestive ointments. 

In cancerous and fungous ulcerations, the obnoxious part should, 
if prominent, be first removed by the knife, but when only beginning 
it may be sufficient to sear it. In sluggish ulcers, its effects are more 
certain than those of any other irritant ; I will relate one case. An 
aged gentleman had been long afflicted with an ulceration on the 
great toe, immediately above the extensor tendon, which, from his 
years, and the imperfect circulation of the part, I had reason to fear 
might lead to dry gangrene. A fair trial was given to the common 
escharotic remedies, such as the kali purum, lunar caustic, &c. the 
sloughs from which separated in the usual time 9 leaving the ulcer in 



Hosack on the Actual Cautery. 67 

its former indolent state. It being then clearly evinced that these 
erosive remedies only extended instead of contracting the ulceration, 
I determined to employ the actual cautery, a single application of 
which produced a complete cure, without otherwise interrupting his 
general health. 

In some instances of atonic ulcer, the hot iron may be advantage- 
ously used without actual application to the body, as when the sur- 
geon does not conceive a destruction of the part necessary, the gra- 
nulations having arrived at the surface, but that surface appearing 
white and inactive, requiring some stimulant to excite the healing 
process. Great benefit may here be derived from the gradual approach 
of the heated iron to the part, and its continuance near it for a short 
time; the surrounding surface will immediately redden, become in- 
jected with blood, and pain will be produced. When the iron has 
been removed, the healthy portion will resume its former appearance, 
while that affected will continue in the state of irritation so necessary 
for its cure. The surgeon must, however, not be disappointed, if the 
ulcer return to the same passive condition, which he should consider 
merely as a call to repeat the application; his efforts will most ge- 
nerally be crowned with success after the second or third trial. 

Before I proceed to the use of the actual cautery in caries and ne- 
crosis, I will offer a few observations upon the pathological difference 
between these two diseases, as influencing their surgical treatment, 
which has not I think been fully noticed. 

The nourishment of bones, and their regeneration when destroyed, 
is effected by means of blood-vessels penetrating their interior, and 
proceeding immediately from the membranes spread over their sur- 
faces. The spongy portions are the most highly annualized, and ad- 
mit of a free circulation, while the cylindrical and flat bones, being 
more compact, can only be penetrated by very minute vessels, and 
therefore require a greater surface of membrane in proportion to their 
mass. Accordingly we find all such portions as it were interposed 
between two membranes which communicate with each other through 
the substance of the bone itself by means of small vessels. This com- 
munication is proved to be necessary to the vitality of the bone, by 
this fact among others, which has been particularly noticed and ap- 
plied by Pott and Mr. Abernethy. Whenever matter has been 
formed or blood extravasated between the skull and dura mater, se- 
parating the latter from the former, the external table immediately 
becomes white, and when scraped will yield no blood; so universal is 
this occurrence, that the distinguished surgeons above mentioned 
consider it as an infallible symptom of a compressing cause immedi- 



68 Hosack on the Actual Cautery. 

atel y beneath, and as warranting the perforation of the skull in that 
spot for its removal. 

Now, were it possible for a patient to exist under such circum- 
stances, we might reasonably expect that the bone would die, and a 
similar suppuration and detachment take place between it and its ex- 
terior covering — here we should have a complete necrosis, for in that 
manner is the disease always formed when it occurs, as in the tibia 
for example. An inflammation takes place in the periosteum, matter 
is formed underneath, and detaches the covering from the bone. The 
internal membrane is also affected in a similar manner, and the bone 
being thus insulated from all means of support, necessarily perishes. 

The separation of the membrane on one side may cause a corres- 
ponding detachment of the other, either because there is an alternate 
inosculation of the arteries in one with the veins in the other, or be- 
cause the number of vessels incapable of enlargement from mechani- 
cal reasons is insufficient for the nourishment of the bone, which 
therefore dies before the second separation takes place. In cancel- 
lated parts the circumstances are very different; their vessels are 
comparatively large, forming strong bonds of connexion with the pe- 
riosteum, and they are therefore endowed with superior powers of 
vitality. Hence necrosis seldom or never takes place in them; but 
on the other hand, they are liable to inflammation and its conse- 
quences, suppuration and mortification, which may go on to a consi- 
derable extent, without any very great change either of the perios- 
teum, or of the adjacent parts of the bone itself. In necrosis there is 
often a regeneration of bone, the dead portion being thrown off in 
mass as a foreign substance. In caries, this cannot take place, and a 
part destroyed can only be supplied by the deposition of purely ani- 
mal matter. These differences should be borne in mind by the sur- 
geon, as they materially change the indications of treatment. 

The use of the actual cautery in caries has been most strongly re- 
commended by Baron Larrey, who has advanced numerous facts con- 
firming the use particularly of the moxa as a counter-irritant. Were 
it possible to apply the hot iron immediately to the seat of the dis- 
ease, our prospects of success would be doubtless much increased by 
this change of atonic and sluggish ulceration to the comparatively 
healthy condition produced by a burn; but such practice is generally 
impossible, from the situation and delicacy of the affected part, as 
of the vertebrae, where it often occurs. In the forming stage of ne- 
crosis, that is, where there is merely inflammation of the periosteum, 
the actual cautery applied at a short distance from the part affected 
will prove a most efficient counter-irritant; but as the surgeon is sei* 



Hosack on the Actual Cautery. 69 

dom consulted until matter has been formed, the disease being gene- 
rally at first mistaken for rheumatism, a different course must be 
pursued, the object is to turn to stimulate and rouse the depressed 
vital powers of the bone and internal membrane, for which purpose 
the actual application of the hot iron to the bone is in fact the only 
means. It is to be remarked that necrosis generally occurs in 
young subjects, while caries is almost entirely confined to those of 
more mature age, and fortunately, as the power of reproducing bone 
in place of that which is dead is more easily accomplished in the 
former than in the latter. Indeed, in the adult, the limb would be 
almost necessarily sacrificed. I will relate a case from my own prac- 
tice, in which the treatment recommended above proved successful in 
arresting necrosis and eradicating its cause. 

Mary F , aged eleven, for some years laboured under an ex- 
tensive necrosis of the tibia, accompanied by a profuse discharge of 
matter from several openings in the leg. Her constitution being much 
impaired by so inordinate a drain, I removed the dead portion: new 
bone was deposited, her health improved, and the wound in due time 
was healed. Before this took place, however, a fluctuating tumour, 
more than an inch in diameter, arose on the other tibia, which she 
informed me was precisely similar in pain and appearance to the com- 
mencement of the former disease. From her account, and from the 
coincidence of the symptoms with those already confirmed by obser- 
vation, I perceived that necrosis was about to take place, and deter- 
mined to prevent it if possible. No opening being yet established, 
an incision about an inch and a half in -length was made obliquely 
across the tibia, and another of the same extent intersecting the first 
at right angles. As I expected, the matter lay between the perios- 
teum and the bone, which was therefore at once laid bare. Each an- 
gle of the wound was then turned back with care, and the whole bony 
surface seared with the white hot iron, it being unnecessary to touch 
any other part. The wound was then filled by a ball of lint, upon 
which olive oil was poured for the purpose of lessening the pain. In 
a few days healthy granulations appeared, the seared surface of the 
bone separated itself by exfoliation from the subjacent part, and the 
wound healed in the time usually required for burns. Her constitu- 
tion has since been improving, she has grown considerably, and has 
every prospect of enjoying a happy existence. 

The vast importance of counter-irritants in diseases of the brain 
and nervous system is too well established to require any argument 
to enforce their use. Here also the actual cautery is principally used, 
but I must observe that it has been productive of injurious, nay fatal 



70 Hosack on the Actual Cautery. 

results when carried too far, by producing inflammation of the cere- 
bral membranes; however, such cases occur so rarely, that they have 
raised no prejudices against the practice in France and Germany. 

Its employment in tetanus in conjunction with the usual sedatives 
is sanctioned by experience, and by the established principles of patho- 
logy. Thus, for instance, a wound is received in the hand, and an 
inflammation takes place in the nerves, extends to the medulla spi- 
nalis, which is then sound and the only medium of communication 
between them and the sensorium. The whole nervous system be- 
comes irritated, and a spasmodic action of the muscles, beginning 
with those of the jaws, is established. The most active treatment is 
now required, and of all others the sedative has hitherto proved the 
most efficacious, assisted by counter-irritants, such as blisters applied 
along the spine near the source of the nerves primarily affected. The 
hot iron offers the most certain and instantaneous means of producing 
the latter results in cases where time is so precious. In the incipient 
stage of the disease the milder treatment may indeed succeed in ar- 
resting its progress, but when once tetanus has been unequivocally 
manifested, we should no longer delay the application of the cautery. 

I will cite a circumstance attending a case of catalepsy which fell 
under my own observation, strikingly illustrating the advantages to 
be expected from this treatment. Oswald H*****, now about twenty- 
two, has been afflicted with this disease from the age of puberty. 
The fits increasing constantly in frequency and duration, threatened 
to undermine his intellect and produce mania, the general termina- 
tion of this class of affections. The disease having resisted all pallia- 
tive means, it was not judged proper to interrupt his advance to man- 
hood by medical treatment; therefore little else remained than the 
guarding his person against self-violence during the severity of the 
attack. In one of the paroxysms, however, it happened that he fell 
into the fire with his head directly against a hot iron, which burnt 
him severely. For some time succeeding this accident, the fits were 
entirely suspended, and hopes were entertained that they had ceased 
to occur: these hopes were, however, soon blighted by their reap- 
pearance when the wound healed. 

For opening psoas and lumbar abscesses, the use of the cautery has 
been revived in Europe from the neglect into which it has for so 
many ages fallen. From the accounts which I have examined it does 
not appear to have answered the expectations formed, and I have 
never myself seen its advantages fairly tested. The reader may 
consult the article Abces by Roux, in the Dictionnaire de Medecine, 
Tome premier, page 64. 



Callaghan on Epidemic Scarlatina Jlnginosa* 71 

In obstinate fistulous openings as sometimes occur after lithotomy, 
great benefit may be expected; we should, however, in these cases 
take care to protect the sound parts from injury, for which purpose 
the dilator for the rectum as constructed by Weaver of London, or 
the common cannula may be used.* It is also recommended by sur- 
geons of eminence for arresting haemorrhages in cases where the ves- 
sels cannot be tied, or where the discharge proceeds from a large 
surface, as after the amputation of a breast, and in recesses of the 
bony structure of the antrum, but in no case have I witnessed its 
successful application; it seems on the contrary always to invite an 
additional determination to the part from the rapidity with which 
inflammation is thus produced. 

New York, January, 1831. 



Art. VI. Account of the Epidemic Scarlatina Anginosa, which pre- 
vailed at Pittsburgh, Penn. in 1830. By D. Callaghan, Licenti- 
ate of the Faculty of Physicians and Surgeons, and Member of the 
Faculty of Medicine of Glasgow, and President of the Pittsburgh 
Medical Society. 

SCARLATINA ANGINOSA appeared in this city in the month of 
May, 1830, and continued to January, 1831, extending its ravages 
throughout the entire mass of the population. Few families have es- 
caped its visitation, and many have to lament the loss of one or more 
of their juvenile members. The crowded and ill-ventilated sections 
of the city suffered most — hence the poor, as in most other epide- 
mics, have been the principal sufferers. The disease was for the 
most part confined to children from one to ten years of age. It com- 
menced with the setting in of the warm weather, about the middle 
of May, the thermometer ranging from 50° to 72°, with southerly 
winds and frequent showers. The first characteristic symptoms of 
the disease, were general lassitude, want of appetite, hot skin, fur- 
red tongue, pain in the head, pain in the small of the back, nausea* 
lips dry, teeth encrusted, swelling of the tonsils, hoarseness, slight 
cough, difficulty of deglutition; about the second or third day the cu- 
tis covered with a scarlet-coloured eruption, restlessness, thirst, 

* I would refer the enquirer for instruments, advised and proper for such ope- 
rations, to George Teiman, manufacturer of surgeon's cutlery, No. 35, Chatham 
street, New York. 



72 Callaghaii on Epidemic Scarlatina Jlnginosa. 

pulse varying from 100 to 140, sometimes fluttering and irregular? 
eyes suffused, rigidity of the muscles of the lower jaw, indistinct ar- 
ticulation, drink returning by the nose, in some cases ulceration of the 
tonsils, delirium, inability to bear the light, swelling of the extremi- 
ties, followed by pneumonia, but more frequently coma, dilated or 
contracted pupil, rigidity of the muscles of the back, head bent back- 
wards, convulsive action, and death. In some cases the symptoms 
were marked with violence from the commencement, and in others 
the disease was so slight as to require little else than the domestic 
prescription of families. 

This disease, although usually classed among fevers of the conti- 
nued type, yet had its alternate periods, a remission in the morning 
and a still more distinct exacerbation in the afternoon. The duration 
of the disease was various, from five to twenty days, its violence ge- 
nerally expending itself during the first twelve days. Not a few of 
the fatal cases were carried off within this period, and some so early 
as the second, third, and fourth days from the first attack. With the 
increase of temperature in the month of June, the disease became 
more unmanageable and fatal. This held good throughout July and 
August, the disease increasing both as to numbers and mortality, as 
we approached the tropical heat of summer. The thermometer rang- 
ing frequently above 90°, and occasionally rising to 96° in the shade 
with southerly winds and dry weather. Vegetation suffered severely, 
the grass of the fields was burned up, and the average crop of corn 
was much diminished from want of rain. The disease now spread 
over several sections of the surrounding country, but with compara- 
tive mildness. After passing the autumnal equinox, inflammation and 
swelling of the tonsils became more severe, and as the cold weather 
of the latter end of autumn set in, this symptom continued to in- 
crease. 

The first premonitory signs of the disease now were hoarseness, 
difficulty of deglutition, and inability of articulation. Severe and ac- 
tive inflammation of the throat, great enlargement of the tonsils, and 
high febrile action of the general system, of a distinctly inflamma- 
tory type. In short, all the characteristic symptoms of cynanche ton- 
sillaris were well-marked. A great many adults now became affect- 
ed with the disease, mostly under thirty years of age, and females 
were more liable than males. No fatal case has come to my know- 
ledge among adults. In them the cuticular eruption was much less 
distinctly marked, and most visible on the legs and arms. The ex- 
tremities were slightly swollen and red, as if from exposure to a cold 
frosty wind, exhibiting a high degree of vascularity all over the cutis. 



Callaghan on Epidemic Scarlatina JLnginosa. 73 

In a large majority of cases, as well in those that terminated fatally 
as in those which recovered, the cutaneous eruption exhibited very 
different appearances. The only permanent feature was the scarlet 
colour of the skin. In some we had a papular, and in others a mili- 
ary eruption, giving rise at one time to the report that measles had 
broke out among us, and at another that the small-pox had returned. 
In some there were a number of red circular spots over different parts 
of the body, assuming a livid appearance previous to death, and a 
mahogany colour afterwards. This, with the ulceration of the ton- 
sils, which frequently took place, gave rise to the idea that the dis- 
ease occasionally assumed a putrid character. The glands of the 
neck frequently swelled and suppurated, particularly in adults, 
after the cold season set in. In children, swelling of the parotid 
glands was a common symptom, but suppuration rare. Pneumonic 
affections were produced in many cases during the cold weather, and 
several children were cut off* from this cause. But of all other causes 
of death, cerebral affections were the most numerous; congestion of 
the brain, inflammation of its meninges, terminating in many cases 
in effusion. In no case was there any post mortem examination; in 
few cases was it asked, and in those few not permitted. 

With regard to the contagious or non-contagious nature of this 
epidemic, the usual process of reasoning, substantiated by facts, 
might be adduced on either side. One child in a family caught 
the disease, and all the others took it in succession. On the con- 
trary, one or more in a family took it, and the others, intermingling 
with them in every possible way, escaped. Hundreds took the dis- 
ease who were not within reach of any one of the affected. Persons 
visiting their relations ill of the disease, returned home and took it 9 
others under similar circumstances had it not. My own opinion is 
that it was not contagious. 

The disease was engendered in, and propagated by the atmosphere, 
and neither transferred nor transferable from one individual to, an- 
other. What constitutes that particular state of the atmospherical 
fluid, capable of giving origin to this particular disease, we cannot 
say, all we know are its effects. Our best constructed eudiometers 
throw but little light on this subject. Numbers becoming affected in 
succession in any particular family or neighbourhood, is only proof of 
similarity of exposure to the original exciting causes of the disease^ 
and susceptibility of constitution to be acted on by these causes. 

During the months of September and October the weather remain- 
ed dry and warm; in November we had some rains, with south- 
easterly winds, and warm weather for the season. December set in 



74 Callaghan on Epidemic Scarlatina Anginosa. 

with rains, but we had little like winter weather until the latter end of 
the month; the winds more easterly. Early in January the winds 
veered about to the north and north-west, the thermometer sunk ra- 
pidly to below the freezing point, in a few days it fell to seven de- 
grees below zero. Towards the middle of the month we had a shift 
of wind to the north-east, with the heaviest fall of snow that has 
been experienced for a number of years; January 20th it was from 
two and a half to three feet deep on the level, the thermometer at 
and below zero, with the wind at north-west. The permanently cold 
weather gave the first check to the disease. Numbers of adults now 
labouring under cynanche tonsillaris with a high degree of inflamma- 
tory fever. 

The treatment consisted in the first stages of the disease, in the 
detraction of blood either generally or locally, or both, the evacua- 
tion of the primse vise by emetics and purgatives, with the cold allu- 
sion, cold bath, or sponging the surface of the body with cold water 
and acetic acid. 

In many cases during the summer months, such was the state of 
apparent debility before medical advice was required, that the utility 
of general bleeding was doubtful. In these cases the application of 
leeches to the head and neck was of signal service. With this useful 
animal we were but scantily supplied, and I do believe that many 
lives were sacrificed, not only from a want of them, but for want of a 
general knowledge of their utility. 

After bleeding, the use of as much of the sol. tart, antimonii as 
would produce an emetic effect, and the cold applications were re- 
commended, followed by purgatives of the sub-mur. hydrargyri in the 
younger children; and in the elder in combination with some of the 
vegetable purgatives or neutral salts. Soda water was given for drink, 
and the temperature of the surface kept down by continued sponging. 
The head was ordered to be shaved, or the hair very closely cut, and 
kept constantly covered with a single fold of linen wet with acetic 
acid and ice-cold water. In many cases the fond affections of a 
mother for the golden locks of her darling, placed an insuperable 
barrier to this part of the treatment, and ultimately endangered, if 
not sacrificed the life of her offspring. In several cases there was a 
tendency to diarrhoea with fetid evacuations; purgatives were as ne- 
cessary in this class of patients as when the bowels were torpid; sub- 
mur. hydr. combined with pulv. rhei was used generally. If the af- 
fection of the throat was slight, an embrocation of equal parts of spt. 
terebinth., aq. ammoniac, and ol. olivar. was recommended; if severe 
a blister was applied immediately. Inhaling the steam of warm water 



Heustis on the Climate of Alabama, 75 

and acetic acid was also advised. A diaphoretic at bed-time of pulv* 
ipecac, et opii, soothed the patient to rest, and procured a relaxation 
of the exhalent vessels on the surface* which moderated the febrile 
action. The mouth and fauces were directed to be washed or gar- 
gled with the sol. sulph. aluminis, and a few drops of aromat. sulpha 
acid. On the first symptoms indicating the approach of coma, a blis- 
ter was applied to the head or the nape of the neck, extending along 
the spine, or both; the lower extremities immersed in warm water, and 
the pulv. antim. c. phos. calcis, or the tart, antim. combined with 
nit. potassse, given internally. Enemata were of signal service in eva- 
cuating the lower bowels and moderating the febrile action. Some 
practitioners, led away by the theories of the older authors, and pa- 
rents by prejudices ascribable perhaps to the same source, in some 
cases imagined the disease to assume a putrid tendency, and exhi- 
bited during the violence of the febrile excitement, wine, cort. cin- 
chonse, and yeast. To say the least of this practice, it was prescrib- 
ing for a phantom, and exhibiting a poison. 

John Burns, C. M. Regius Professor of Surgery in the University 
of Glasgow, notwithstanding all his practical acumen and extensive 
experience, both in his public lectures and in his writings, has in- 
culcated the idea that scarlatina is a contagious disease, (vide Prin- 
ciples of Midwifery, page 542.) I have seen it prevail extensively in 
Europe in the most crowded populations, and I have seen it here y 
and must confess I never saw any thing to warrant such an opinion, 
The numbers which have been cut off in this epidemic must be con- 
siderable, but as no records are kept, we can give no account of the 
amount. Recoveries were often lingering; in many cases the sulphate 
of quinine acted as a valuable tonic, in restoring to an enfeebled 
frame the wonted vigour of health. 

Pittsburgh, 1831. 



Art. VII. Topographical Remarks on the Climate, Soil, fyc. of the 
middle section of Alabama, more especially in Relation to the 
County of Dallas. By J. W. Heustis, M. D. of Cahaba, 

Kj AH ABA, the chief town of Dallas county, is situated in about 32° 
20" of north latitude. The Alabama river runs through the county 7 
dividing it from north to south. The Cahaba river also passes par- 
tially through it, mingling its waters with those of the Alabama, at 



76 Heustis on the Climate of Alabama. 

this place. There are besides, several creeks of considerable size, 
the principal of which, are Bogue, Chito, and Cholatche; the former 
is nearly one hundred miles in length, by the way of its meanderings, 
the latter is much smaller, and forms the southern and western 
boundary of the county. 

This is a lime stone county, and particularly so in the vicinity of the 
prairies, of which there are some of very considerable extent in this 
and the adjacent counties: in many places it is moderately broken 
and undulating; never, however, rising into lofty hills, but abound- 
ing in precipices and caverns. The substratum is composed of 
mountain, or transition lime stone, softened, in most instances, by a 
considerable admixture of clay, and in others indurated by the pre- 
sence of silica; the former, or soft lime stone, is by far the most 
common. About sixty miles above this place, the country becomes 
very broken and hilly, the lime stone assuming more of the primary 
character, and is mixed with a considerable proportion of sand stone; 
in every place the latter mostly prevails. This is considered as the 
latitude of the golden region, and discoveries authorizing this charac- 
ter have lately been made. A silver mine is also said to have been 
discovered upon the Cahaba river, about seventy-five miles above 
this place: the disclosure was made by an old man, who had been 
employed to work in the mine by the Spaniards, more than fifty years 
ago. Iron ore is here also common; beds of coal may be seen in the 
banks of the Alabama, at low stages of the water, embedded beneath 
a deep stratum of lime stone. This section of country is of alluvial 
formation. Jasper and pebbles of various descriptions and sizes are 
found in great abundance upon sandy and gravelly ridges, and in 
the banks and beds of the rivers and smaller streams. Too little 
attention, however, as yet has been paid to the subject in this state, 
to ascertain the extent and value of its mineralogical treasures. The 
rivers and creeks have generally one of their banks composed of lime 
stone, and the other of more recent alluvial deposite. 

There is in this county a very considerable proportion of fertile 
land, confined principally to the rivers, creeks, and prairies: the up- 
land in other situations is generally thin and sandy, yet when of mo- 
derate fertility, it is often preferred on account of the purity of the 
water, and healthfulness of situation, to the less salubrious though 
more productive lands near the rivers. Perhaps there is no country 
possessing a greater variety of soil, and in which sudden changes take 
place more frequently from fertile to poor, and vice versa; or in com- 
mon parlance, where the land is more spotted : not unfrequently a 
space or strip of a few yards constituting the boundary between lands 



Heustis on the Climate of Alabama. 77 

of very poor and of very rich quality. It would seem, that with the 
exception of the more recently formed rich river lands, this great and 
sudden variation in the soil is owing, in a considerable degree, to the 
depth or proximity of the subjacent lime stone to the surface. There 
can be little doubt that this lime stone possesses the property of great 
fertility. Thus, when the bald prairies , so called from being destitute 
of trees, and covered only with grass and herbage, when these have 
been cultivated and broken up deep, with a strong plough and team, 
by which the lime stone becomes pulverized, and converted into 
mould; these places, which before were barren and unproductive, are 
converted into soil of great fertility. In this way, also, we may 
probably explain the richness and depth of soil along the skirts and 
margins, and in the bottoms or hollows lying in the vicinity of the 
lime stone, or bald prairies, prominences, and hills; the wear, attri- 
tion, and decay of ages absorbing the lighter parts and portions of 
this calcareous animal deposite, which, mixing with the remains 
of extinct and decaying vegetation, lodges upon the sloping declivi- 
ties, and in the vallies, forming beds and strata of great depth, fer- 
tility, and duration. The land not only of this county, but also of 
most others in the state, may be divided into six natural varieties, or 
classes. First, the side river bottoms, or swamps as they are called, 
subject to inundations. Second, the more elevated river lands of 
inferior quality, and not subject to overflow. Third, hommock, or 
second river and creek bottom, or low grounds of a loose black, sandy 
soil, fertile, and above inundation. Fourth, first quality of upland, 
of intermediate fertility between the hommock and second quality of 
upland. Fifth, second quality of upland, consisting principally of 
piney woods, interspersed with a few oaks, hickories, &c. Sixth, 
prairie. The extent of the first division, or river bottom, is ex- 
tremely various and irregular, being sometimes a mere border, of not 
more than forty or fifty yards in width, and in others extending from 
one to two miles from the river; and, in other situations again, the 
second quality of upland or piney woods, reaches to the very river, 
forming high and precipitous bluffs. Generally, where one bank of 
the river or creek is formed in this manner, the opposite one is low, 
with a greater or less extent of rich river or creek bottom. Before, 
and at the first settlement of this country by the present white po- 
pulation, the rich river lands were covered with thick gigantic cane, 
this, since that time has, in many places, been entirely destroyed by 
accidental fires, and by cattle, which are extremely fond of it, espe- 
cially when young and succulent, at which time they eagerly devour 
the whole plant. Thus, when the old cane dies, as it does sponta- 
No. XV. —May, 1831. 8 



78 Heustis on the Climate of Alabama. 

neously in a few years, after going to seed, as none of younger growth 
has been left to succeed, the crop is entirely destroyed. There is, 
however, in this state, a considerable proportion of cane land, remote 
from the rivers and creeks. It is scarcely necessary to say, that 
land of this description is of the first quality. Where the growth of 
cane is not situated on the rivers and creeks, or, in other words, 
where the soil which produces it is not made land, the result of al- 
luvion and inundation, it is of prairie or lime stone quality. There 
is a considerable extent of country of this description, commencing 
about twenty-five miles from this place, lying principally in the 
county of Maringo, cornering also in Dallas, Perry, and Green. The 
soil here is a rich vegetable mould, several feet in depth: but like the 
prairie country generally, it is badly watered. For a distance of 
thirty or forty miles, in one direction, the traveller finds not a single 
running stream; and if, by chance, he discovers a little water in a 
stagnant pool, he "blesses his stars, and thinks it luxury." Besides, in 
the winter and spring, the roads, as might be supposed, are muddy 
in the extreme. Notwithstanding these disadvantages, the ex- 
treme fertility of the soil in the Big Cane Brake, as it is called, 
causes it to be fast filling up with a wealthy and industrious popula- 
tion. Those in better circumstances have bored through the subja- 
cent lime stone, and found tolerably good water, at the depth of be- 
tween two and three hundred feet.* Others dig about in sink holes, 
and collect and use the water that drips and filters through the soil, 
and is arrested by the rock, forming stagnant pools, which, though 
warm, brackish, and sulphury to the taste, rarely or never putrefies. 
Others again, have cisterns, or large excavations, which hold the 
water collected from the rains. From the scarcity of water, it is a 
bad country for cattle, which often perish from the want of this ne- 
cessary element. There is, besides, much fertile land in the prairies 
themselves, which, however, though in a less degree, are subject to 
the same inconvenience and objection, scarcity of water, and that of 
a bad quality. During the dry weather of summer, cattle, hogs, &c. 
suffer much from the cause above mentioned, and as the pools dry 
up, a stiff mud occupies their places, in which those animals, in their 
search for water, often sink, and being held fast by the legs, soon 
perish, unless discovered and extricated in time. There is one thing 
of a singular character observed among the cattle of the prairies, 
which is the deposition of black or dark grey matter in the omentum, 

* In tbe prairie lying in Montgomery county, I have been told one man has 
bored and found good water at the depth of five hundred feet, the water rising 
within seventy feet of the surface, to which depth he has sunk his well. 






Heustis on the Climate of Alabama. 79 

mesentery, and in the peritoneal covering of the stomach and intes- 
tines: this is frequently found in patches as large as one's hand, and 
appears to consist of mud or lime stone; having become redundant in 
the system from the quantity of impure and muddy water which these 
animals are obliged to make use of. It is probable that this may be 
one cause of the murrain, to which they are very subject, and of 
which they die off in great numbers, with blood issuing from every 
orifice in the body. The disease, for the most part, is extremely 
painful and short, destroying life in a very few hours. 

There is in this country a vegetable growth, of which cattle are 
very fond, but which, I believe, has never yet been satisfactorily as- 
certained, which communicates a most disagreeable taste and odour, 
(bearing some affinity to that of onions,) to every part of the body. 
The breath of cattle which have fed upon it is particularly noisome 
and disgusting. The taste, in a few hours, is communicated to the 
milk of cows, rendering it extremely unpleasant and unfit for use, 
unless among persons of obtuse and unrefined sense of taste, or to 
whom the long habit of using it may have overcome the natural dis- 
gust of a first acquaintance. This vegetable, called the weed, does 
not appear to impart any poisonous quality to the milk or flesh of 
animals feeding upon it, as no injury has ever been known to result 
from their use. The milk of cows that have fed upon this weed, 
even communicates its odour to the breath of persons who have taken 
it freely. The flesh of animals is thereby still more strongly impreg- 
nated than their milk, and its taste is so extremely unpleasant that 
no person can endure it. In cows that are kept up, the taste disap- 
pears in a day or two from the milk, but a longer time is required 
for its removal from the flesh. It is probable that the sensible quali- 
ties of this plant undergoes a very material change under the con- 
cocting operation of the digestive organs, so as to elaborate a taste 
and odour not discoverable in the fresh and growing weed; otherwise 
it would have been impossible for it to have remained so long a mat- 
ter of doubt and uncertainty. 

A great proportion of the houses in this section of the state are 
built of logs, as being of more convenient and expeditious construc- 
tion. In the towns, however, of any considerable standing, framed 
buildings have in most instances taken the place of the more rudely 
constructed log cabins. As might be expected in a new country, 
where the immediate necessaries are of primary consideration, but 
little attention is generally paid to the more refined comforts and 
elegancies of life. Gardening of every description is very much ne- 
glected, except among the more wealthy; and though the heat of our 



80 Heustis on the Climate of Alabama. 

summers is unfavourable to horticulture, yet by taking proper advan- 
tage of the winter and spring, vegetables of almost all the ordinary 
varieties may be cultivated and reared with very considerable suc- 
cess. No climate is perhaps better adapted to the growth of the egg- 
plant and tomatoe, (Solanum melongena and Solanum lycopersicon. ) 
To the Irish potatoe, as it is improperly called, (Solanum tuberosum,) 
the country is less congenial, though by planting it early in the 
month of February, it is much relied upon as an early garden vege- 
table; it is generally thought, however, that the seed degenerates in 
the course of two or three years, and requires the substitution of that 
which is fresh from the northern states; as far as my own observation 
extends, I am by no means warranted in the support of this opinion, 
having almost invariably obtained better potatoes from seed of my 
own raising; and it is a well known fact that the potatoes imported 
from Ireland, as they often are, are in this climate entirely unpro- 
ductive, yielding vines or tops in abundance, but no tubers. The 
sweet potatoe, (Convolvulus batatas,) in all its known varieties, lux- 
uriates here in the greatest abundance, and is to the inhabitants of 
the southern states, what the Solanum tuberosum is to those of the 
northern. Melons of all kinds succeed to admiration, and are much 
used by the inhabitants; with many, however, as well physicians as 
others, there is a strong, though I am satisfied an unjust prejudice 
against them. Does it appear reasonable, I would ask, that a fruit so 
grateful to the taste, so cooling to the body, and at the same time, 
that operates so freely and mildly upon the various emunctories of the 
system as the water-melon, should with all these alluring tempta- 
tions and specious properties, contain a secret poison ? The notion 
is absurd, and would convert a blessing, designed by our benefi- 
cent Creator for our comfort, into a baneful and forbidden fruit. The 
same observations apply to all the ordinary fruits of the season; and 
there can be no doubt that they are all alike intended by a kind Pro- 
vidence for our health, comfort, and enjoyment. Throughout the uni- 
verse, as far at least as our limited observation can extend, we find 
that the God of nature has wisely adapted the various means and ob- 
jects of creation to their appropriate design. Nothing is fortui- 
tous, accidental, or improvident. Every animal is adapted and form- 
ed to its particular sphere of life and mode of existence. Where rea- 
son fails, instinct supplies its place, and directs the inferior creation 
with almost unerring certainty to the gratification of their natural 
wants and desires. But to man was given a wider range and a more 
extended field of enjoyment. The intellectual world opens its re- 
sources to the pursuit and gratification of his more noble faculties^ 



Heustis on the Climate of Alabama. 81 

whilst the wide-spread earth, with its diversified objects of the ani- 
mal and vegetable worlds, are presented in ample profusion for his 
corporeal gratification. And when panting under the oppressive in- 
fluence of a vertical sun, can any thing be better adapted to quench 
the thirst and allay the feverish heat of the body, than the cooling 
acidulous fruits of the season— the orange, the lime, the lemon, the 
pine apple, the grape, the peach, &c. &C. ? These are the antidotes 
which nature has kindly provided for our health and well-being 
against the influence of heat and malaria, and is it not the height of 
folly and absurdity to suppose, that like the forbidden fruit of paradise, 
they contain the poisonous properties of misery and death? But defer- 
ring this subject to another occasion, I return from my digression. 

The peach, (Amygdalus persica,) arrives in this climate to great 
perfection, and bears fruit in the greatest abundance. Of the plum, 
there are a considerable number of native varieties, which are good 
bearers, though the fruit, for the most part, is rather watery and in- 
sipid; to the exotic varieties the climate is unfavourable. The fig 
succeeds but indifferently, though it is much benefited by being 
placed near the shelter and protection of a wall or building, so as to 
shield it from the severity of the early frosts, which are apt to injure 
and kill the succulent branches, whilst the sap is in the full tide of 
circulation in the fall. The country is rather unfavourable to the ap- 
ple and the pear, the first being often a good bearer, but generally of 
slow, difficult, and uncertain growth; the bark being much infested 
with insects, producing ugly and hurtful excrescences. To this dis- 
ease the quince is especially liable. I have never seen a pear in the 
state, though I have been told there are some of good quality in the 
neighbourhood of St. Stephens. The apricot flourishes finely, but as 
far as my observation extends, is unfruitful. The cherry, except the 
wild, is here generally of slow and sickly growth. The currant, as 
well as the gooseberry, for tne mos t part, wither and die the first 
year, or if they survive, as they sometimes do, when well protected 
by the shade of a building, they are still languishing and unproduc- 
tive. But few experiments have as yet been made with the grape, 
and it appears that the high expectation held out by the French set- 
tlement near Demopolis, so liberally patronized by government, 
has ended in total failure. This perhaps may be ascribed in a 
great degree to the quality of the soil, which is of the prairie cha- 
racter, and as such is found to be very unfavourable to the vine. 
The native grape is mostly of a small, black, dry, acerb, and in- 
ferior quality. There is every reason to believe, however, that 
with proper skill and care in the cultivation, many excellent varie- 

8* 



32 Heustis on the Climate of Alabama. 

ties of exotic grapes might here be made not only a great source oi 
healthful luxury, but also of individual profit. Time must test the 
practicability of naturalizing the olive; and although the probability 
is that the mean temperature of this section of country is greatly su- 
perior to that of the south of France, yet the sudden and sharp frosts 
in November, or the latter part of October, often gives such an im- 
mediate check to vegetation, as to prove prejudicial and dangerous 
to the more delicate and less hardy trees and shrubs. Were it not 
for this irregularity, the orange would doubtless flourish and bear 
fruit: thus I have known it to resist the ordinary frosts of three or 
four successive winters, and to be cut down in the fourth or fifth. 
This tree, however, is cultivated with some success in the city and 
vicinity of Mobile. Grain of all the ordinary varieties generally suc- 
ceeds well, with the exception of wheat, which if too late is injured 
or ruined by the rust, from the hot weather in the latter part of May, 
or if too early, is destroyed by the frost in February or March, and 
even sometimes in the month of April. Thus the severest weather in 
1828, happened on the fifth, sixth, and seventh of April. The ground 
for three successive nights was hard frozen; the Indian corn that 
had been up and growing, was bitten to the root, and required to be 
replanted; the wheat was almost every where cut off, fruit was de- 
stroyed in the germ, and many trees in the forest were killed. Wheat 
is, therefore, rather an uncertain crop, though still cultivated by 
many farmers in sufficient quantity for their own use, and not un- 
frequently to dispose of. In seasonable years the grain is remarkably 
large and heavy. 

Of trees, the Melia azederach, (Pride of China,) is much esteem- 
ed by some, on account of the rich and polished verdure of its leaves, 
the density of its shade, and the rapidity of its growth. The whole 
tree possesses highly anthelmintic properties, these virtues residing 
more especially in the root. Caution, however, is required in its ex- 
hibition, as in too great quantities it is highly poisonous, affecting 
more especially the head and eyes, sometimes causing total blind- 
ness. The forest trees consist on the upland principally of oak, pine, 
chestnut, hickory, dogwood; s in addition to which, near the rivers 
and creeks, and on land of first and second quality, we may men- 
tion the liquidambers, nyssa, platanus occidentalis, several species 
of elm, ash, sugar maple, flowering maple, beech, holly, honey lo- 
cust, black walnut, cedar, sassafras, red bay, large laurel, or mag- 
nolia, several inferior varieties of bay, white poplar, mulberry, tu- 
pelo, cotton wood, linden or bass wood, &c. &c. 

At the first settlement, this country was much infested with bears 



Heustis on the Climate of Jilabama, S3 

and wolves, which were very destructive to the herds and flocks of 
swine and sheep, more particularly about the rivers, and in the neigh- 
bourhood of thick woods, swamps, and cane-brakes 5 but as the country 
fills up with a denser population, these wild beasts are gradually de- 
stroyed and disappear. The bear tribe, however, though much dimi- 
nished, is still troublesome in many places, breaking into plantations at 
night, and committing great ravages upon the Indian corn, of which, 
in its green or milky state, this animal, epicure as he is^ is extreme- 
ly fond. Deer are still numerous, as are also wild turkeys, and form- 
ed a great portion of the subsistence of the first settlers. These ani- 
mals and fowls are much hunted, more particularly the former, by 
persons fond of the chase, as those of the south generally are. 

There is a species of locust which sometimes abounds here in im- 
mense quantities. In shape it resembles the common locust, differ- 
ing in colour, which is of a reddish cast. Its noise resembles the 
croaking of a frog. They are said to make their appearance in seven 
years. Last year the country swarmed with them. They appear to 
live by suction. They are furnished by a strong sharp bill or pro- 
boscis, with which they perforate the leaves and tender twigs and 
extract the juice. They are but of short duration, and previously to 
their disappearance, they deposit their eggs in the centre of young 
and succulent shoots, which they perforate for the purpose with a 
strong, horny, and pointed tail with which they are furnished. These 
eggs in a few weeks hatch out, and form small white worms, which 
immediately descend into the earth, and there remain, till the ani- 
mal acquires maturity and becomes a creeping chrysalis, when it again 
perforates the ground in its ascent, and attaching itself by its claws 
to the nearest tree or plant, bursts its investing shell upon the back, 
and becomes a winged insect of the air and groves. 

Rattlesnakes have much diminished of late years; they are still, 
however, tolerably numerous, and almost every family takes precau- 
tion against them, by having a vial of liquid ammonia in the house; 
this is given as soon as possible after the bite, in the quantity of a 
tea-spoonful, in water, every ten or fifteen minutes until relief is 
obtained. Given in this way, and applied to the part, it is said to be 
an effectual and sovereign remedy. Deaths, however, sometimes oc- 
cur very suddenly from the bite of this venomous reptile, though 
none have fallen under my own observation. A fatal case occurred 
a few miles from this place a few weeks since, in a lad about twelve 
years of age. The bite was inflicted on the ankle; the limb was cord- 
ed below the knee, but in a few hours swelled so prodigiously that 
the ligature was removed, and applied above the knee, still the swel- 



S4 Heustis on the Climate of Alabama. 

ling increased, the leg below the knee turned black, cracked open, 
and became gangrenous; the mortification at length attacked the 
thigh, and extending to the body, destroyed life the fifth day. Such 
was the intensity of suffering and pain, that aberration of intellect or 
delirium soon came on after the injury, and continued with little in- 
terruption to the fatal close. After death the body swelled immense- 
ly, turned livid, and the dissolved blood exuded through the pores of 
the skin. A variety of popular remedies were tried, though without 
the advice of a physician. The above history I gathered from the 
parents after the death of their son. 

Of the serpent order there are a great variety, though but few are 
poisonous. There is a rare species, about six feet in length, a speci- 
men of which I forwarded a few years since to Dr. Mitchell, of 
New York, who considered it a species of the boa, though it had not 
hitherto been described by any naturalist. Considering the number 
of venomous reptiles and insects in this country, it is rather surpris- 
ing that accidents and injuries from them do not happen more fre- 
quently. There is an insect peculiar to warm climates, which, ac- 
cording to its size, is represented as being very venomous. This is 
the large, solitary, red ant. It is from an inch to an inch and a quar- 
ter in length, with a body larger and longer than that of the honey- 
bee, but more round and more elegant in its form, of great strength 
and activity, and protected with a very hard and apparently crusta- 
ceous covering; it is clothed with a short velvet down, and has two 
black spots, one on the body or thorax, and another on the tail or ab- 
domen superiorly; its sting is about a quarter of an inch in length. 
Ticks and red bugs are also very numerous and troublesome; the lat- 
ter are scarcely discernible to the naked eye, appearing like very mi- 
nute red points; they fasten themselves in the skin, create a burning 
sensation, and a very severe itching, and in children and young peo- 
ple, unless removed in time, giving rise to painful and tedious ulce- 
rations. They are different from the chiego of the West Indies and 
Florida, which burrows and breeds in the thickened cuticle of the 
feet of the negroes, and beneath the nails, producing a bag or cyst, 
like a hydatid, and sometimes working their way entirely through 
the joint, so as to cause the toes to come oft". The red bug, on the 
contrary, remains solitary, and does not generate in the skin; they 
abound in the woods, and about old decaying timber. Mosquetoes 
are not generally numerous, unless in certain wet or marshy situa- 
tions, or after great rains. They always require stagnant water for 
their production, and as regards locality and health of situation, may 
therefore be looked upon as an unfavourable omen. 



Heustis on the Climate of Alabama, $5 

The white population of this section of country, as well indeed as 
of other portions of the state, consists principally of emigrants from 
North and South Carolina and Georgia. The next most numerous 
portion are Tennesseans, then follow the Virginians, New Engend- 
ers, and others, from every state and section of the Union. To these 
may be added not a few Scotch, Irish, Dutch, French, Swiss, &c» 
Such diversified materials compose the population of most new coun- 
tries, which amalgamating by intermarriages, in the course of one or 
two generations becomes more assimilated and national in its charac- 
ter. It is now the land of their adoption — it will then be the land of 
their birth: old and cherished prejudices, and fond recollections and 
regrets of dissevered kindred and friends and native country will die 
away with the present stock, and new feelings and associations of in- 
digenous growth spring up with the rising generation. 

In a land possessing so many natural advantages, it was readily 
to be supposed that the wealth of the country must be rapidly in- 
creasing. The extensive range of the grass and cane of the woods, 
swamps, and prairies, and the mildness of the winters, renders any 
provision, except a little salt, unnecessary for the cattle, which are 
consequently cheap and plenty. All the comforts of life are raised 
in the greatest abundance, besides a vast amount of surplus staple 
for exportation. The returns made to the planter, after paying off 
his store account contracted during the year for groceries, and sundry 
articles of luxury or convenience, is laid out in the purchase of land 
or negroes, and thus the numerical force and riches of the country 
goes on increasing in geometrical progression from year to year. To 
this rule there are certainly exceptions, both among merchants and 
farmers, who, by imprudence and mismanagement, sometimes come 
to poverty and ruin. Instances of this kind appear to occur more 
frequently among the farming part of the community than others, 
and the reason is obvious; for as agricultural labour is here princi- 
pally performed by slaves, with the exception of the poorer class, 
under the conduct of an overseer, the proprietor has much leisure 
upon his hands, which is often spent in hunting, drinking, and con- 
vivial associations. Those hours which by a northern man are gene- 
rally devoted to intellectual or corporeal labour and application, 
are here, by the idle and more wealthy, frequently spent in recrea- 
tion, sport, and too often hurtful and demoralizing dissipation. 
Much time in this manner runs to waste, which might and should be 
husbanded to accounts, in the acquisition of useful information, and 
in building up a character of improved talents, and scientific and 
literary accomplishments. The militia musters throughout the state 



36 Heustis on the Climate of Alabama. 

are, almost always, attended with much disorder, drunkenness, and 
fighting. At such times and places, persons holding grudges and 
old animosities against each other, often suffer their passions to rise 
with the warming, exhilirating and courage-stirring influence of spiri- 
tuous potations; fights ensue, and sometimes death is the consequence. 
There is certainly a vast amount of drunkenness in this state; and 
although the principles of the temperance society have had some in- 
fluence in arresting the extent of the wide-spread havoc, yet the re- 
sorts of dissipation, the bar-room, grocery, and tippling shops still at- 
test the extreme and alarming prevalence of intemperance. The 
retailer of spirituous liquor has probably a greater amount of crime 
and responsibility to answer for than any other person in society. 
Laws are passed for the punishment of overt acts of personal violence, 
assaults and outrage, and yet the most efficient cause of all this mis- 
chief, the man who scatters abroad " fire brands, arrows, and death," 
is tolerated and protected in society, and even looked upon, or 
rather overlooked as innocent. 

It is scarcely necessary to say, that cotton is here the staple arti- 
cle of growth and exportation. Many of the farmers, however, of 
the middle and southern sections of the state, are now turning their 
attention to the sugar-cane; and from the small trials that have been 
made, with every prospect of success. 

There is here a long continuance of hot weather, which generally 
commences with considerable intensity about the 10th or 15th of 
May, and lasts until about the middle of September. Thus we have 
four months of hot summer weather. From the middle of September 
to the middle of November, the temperature is mild and pleasant, 
the nights cool, and the days comfortable. The same may be said 
of the period embraced between the 15th of March, and the 15th of 
May. Thus, in relation to the general temperature, we may divide 
the year into three equal parts; viz. the cold, the temperate, and 
the hot seasons; the temperate season being nearly equally di- 
vided by the intervention of summer or winter. The cold of winter 
is seldom severe or long-continued, and from the great proportion of 
warm and temperate weather, the country is remarkably exempt 
from pulmonary consumptions; this disease scarcely ever appearing 
except in persons strongly predisposed by hereditary conformation. 
I have known several persons affected with catarrhal phthisis, from 
neglected and improperly treated pneumonic affections, who have 
finally recovered a comfortable share of health after a protracted ill- 
ness. Persons affected with phthisis pulmonalis, or a great predis- 
position to that complaint, experience very decided benefit from a 



Heustis on the Climate of Alabama. S7 

residence in this climate. Comparatively very few deaths take place 
from this disorder, probably not more than one in two hundred of 
all the fatal cases from every disease. The salutary influence of 
this climate in phthisical invalids, I am persuaded, requires only to 
be known to be taken advantage of, and duly appreciated. In the 
year 1815, I embarked from New Orleans for New York; among the 
passengers was a delicate young gentleman, who had resorted to the 
climate of Louisiana for his health: his chest was small and com- 
pressed, and evidently of the phthisical conformation. Yet he ap- 
peared, at this time, to enjoy a very tolerable and comfortable share 
of health. It was now the month of April, and as we lay in the 
Mississippi waiting for a favourable wind, the weather was extremely 
warm, and we were much annoyed with mosquetoes: yet there was no 
sickness among us; and even our phthisical invalid was hearty and 
cheerful, enjoying the comforts of the table, and participating in the 
pleasures of the social circle. He had no cough, wheezing, or apparent 
difficulty of breathing. After a safe and pleasant passage, we arrived 
at New York on the 8th of May. As we approached the harbour, the 
land air around us felt damp, chilly, and uncomfortable. This was 
more particularly experienced by our consumptive companion. As 
we were detained a day or two by quarantine, he grew sensibly 
worse. Upon landing, and walking only a few hundred yards, he 
found himself quite out of breath, exhausted and overcome. We 
parted, and I looked upon his fate as speedy and certain. He should, 
certainly, at the expense of all reasonable pecuniary sacrifices, have 
taken up his residence in a country which he had found so congenial 
to his health; at least until his system and pulmonary organs had be- 
come invigorated, and the fatal predisposition had been replaced by 
a sound and healthy constitution. Had the lamented Dr. Godman 
also pursued this course, many years, in all probability, would have 
been added to his valuable life; and medical science, and the cause 
of humanity would still have been benefited by his talents, and his 
labours. 

Although, as previously stated, the winters are not generally long, 
or very cold, yet I have, at sundry times, known the weather quite 
severe for several days successively. Thus, on the 6th and 8th of 
February, 1824, the mercury in Fahrenheit's thermometer, at sun rise, 
stood at 8° degrees above zero. Water standing in tubs and buckets, 
was frozen solid, and the earth for the first and only time since I 
have been in the state, which is now ten years, was covered with 
snow for nearly two days. This severity of weather extended 
throughout the southern section of the union, killing the fig and 



88 Heustis on the Climate of Alabama. 

orange trees to the ground. On several days since then, I have seen 
the mercury as low as 15° or 16°; such instances however are rare. 

During the summer the prevailing wind is westwardly, varying 
from the south-west to the north-west. After a general rain the wea- 
ther often clears off with a strong or fresh wind from the north-west. 
Rain-bearing clouds come from any point southwardly from the south- 
east to the south-west. From the east northwardly to the north-west, 
and so on to the west-south-west, the winds are dry, unless there has 
previously been a prevalence of southwardly winds, when showers 
sometimes spring up from the north, by a sudden condensation of va- 
pours which are driven back to the south. The wind in winter fre- 
quently sets for several days together, from the north-east; the air is 
then damp, chilly, and disagreeable, and the sky dappled and over- 
cast with fleecy clouds, the weather being such as in the Atlantic 
and eastern states would indicate snow or sleet; but before the clouds 
arrive here their humidity has been precipitated, so that we perceive 
only the rack of the Atlantic storms. In winter the winds are ex- 
tremely variable, after a rain blowing keen and cold for a day or two 
from the north-west; then veering to the south, and bringing us the 
atmosphere of the tropics, cooled and tempered in some degree by 
admixture with that of more northern latitudes. It is scarcely neces- 
sary to say that these changes of the wind from north to south, and the 
contrary, are productive of great and sudden changes in the tempe- 
rature of the weather, which from a degree mild and pleasant, often 
sinks to the freezing point in the course of twenty-four hours. As 
our cold weather comes principally from the north, being scarcely in- 
digenous to the climate, it is obvious that a prevalence of winds from 
any point north of west or east must produce a diminution of tempe- 
rature. This is more especially the case with winds from the north- 
west, since they come from a bleak frozen country, clothed with fo- 
rests and covered with snow, or from inland seas, shaded and bound 
up in semi-perpetual ice. 

Droughts of several weeks duration are very liable to happen in 
the summer months. Thus, during the hot weather of 1826, there was 
an extensive drought, in many places of the middle and southern 
portions of the state being of nine or ten weeks duration* only very 
few places being visited by light and partial showers. The same kind 
of weather, I believe extended throughout the greater portion of the 
southern states. In many places the Indian corn was totally burnt 
up and killed to the very top. June is generally dry, literally veri- 
fying the old Saxon appellation of sero monah, dry month. At this 
time, July 3d, there has been a long spell of dry weather, and the 



Heustis on the Climate of Alabama. 89 

crops were fast withering and dying. A fine rain, however, yester- 
day, from the south- westj came in seasonable time to arrest the work 
of destruction, and revive the drooping spirits of the farmers. The 
month of April last was almost unprecedented for dryness, but one 
or two small showers having fallen during the whole month. The 
summers of 1822 and 1823, on the contrary, were unusually wet, 
more especially the latter, the earth during the months of July and 
August being drenched and inundated with floods of rain. On the 
22d of April, 1822, there occurred the highest fresh ever known since 
the settlement of the country by the whites: the town of Cahaba was 
laid almost entirely under water, in some places to the depth of six 
or eight feet. Of late years the rain has been much less abundant, 
and there has, in the mean time, been a very considerable improve- 
ment in the health of the country: whether this has been owing to any 
change in the state of the atmosphere, or to any obvious alteration of 
the weather, or to the acclimation or seasoning of the inhabitants, or 
to all these causes, is not for us to determine with absolute certainty. 
Much, however, I think may be ascribed to the latter of the above 
circumstances; for it is now found, that although the old and accli- 
mated residents enjoy almost uninterrupted health, with nearly com- 
plete exemption from bilious fevers, yet whenever a stranger arrives 
from the eastern or northern states, or even from Tennessee or Ken- 
tucky, they are pretty certain to experience an attack of the endemic 
fever under a character of greater or less severity, and which some- 
times, under improper treatment, terminates fatally. 

The Alabama river is at this time, September 8th, lower than I 
have ever known it, being fordable in many places. Many springs of 
water, which before have never been known to fail, are now quite 
dry. August has been uniformly hot, with the exception of the nights, 
which towards the latter end of the month would become cool and 
comfortable before day: during the hottest part of the twenty-four 
hours, the mercury of Fahrenheit, in a cool and ventilated apartment, 
has stood above 100°, and for several days in succession has exceed- 
ed 90°. I perceive from the journals that the heat in the northern 
states has been more than usually intense this season, many persons 
having perished from the heat, and from the imprudent use of cold 
water while in a fatigued and heated state. As the temperature of 
well water must be nearly the mean temperature of the climate, it may 
readily be supposed that the water here is never sufficiently cold to 
be productive of any serious consequences; accordingly, I have never 
known any accident to arise from this cause. 

It is probable that the dispersion of humidity, and the diminution 

No. XV .—May, 1831. 9 



90 Heustis on the Climate of Alabama. 

m the quantity of rain may have had considerable influence in ren-* 
dering the country more healthy, and more exempt from the endemic 
fevers of summer and autumn. The settlement and first cultivation 
of new countries is generally extremely prejudical to the health of the 
lately-arrived inhabitants; the vegetable matter that had been accumu- 
lating for ages, undergoing a great and sudden decomposition, infects 
the air with noisome exhalations, from the inability of the recent ve- 
getable growth to appropriate to its increase and support the exces- 
sive supply and redundancy of putrefactive products. 

For the last few years more injury has been sustained from a defi- 
ciency than from too great a quantity of rain. What connexion this 
may have with an increased and greater uniformity of temperature 
during the summer season, I am unable to say, though it would ap- 
pear that as we approach the more uniformly heated and equatorial 
latitudes, rain becomes less frequent and considerable, except in hilly 
and mountainous districts of country, where elevation counteracts the 
natural influence of approximation to the equator. 

It would seem, that as the country becomes settled, cultivated, 
and improved, and the forests proportionably diminished by the la- 
bour of agricultural industry, the atmosphere is rendered less humid, 
the vapours and exhalations are more suddenly dissipated, and the ag- 
gregate quantity of rain is lessened. To illustrate this fact in a scien- 
tific and satisfactory manner, it would be necessary to compare the 
quantity of rain that had fallen during the first four or five years af- 
ter the first settlement of the country, with that of a like duration 
immediately preceding the present time; but as we possess no such data, 
we can only judge from obvious circumstances, among which we may 
mention the annual state* rise, and degree of inundation of our rivers. 
It is well known that our freshes have become of late years much 
less frequent and considerable. This may, perhaps, be partially as- 
cribed to the more rapid evaporation of humidity after rains, in con- 
sequence of the earth being more freely exposed to the action and in- 
fluence of the solar rays from the operation of clearing. The rains of 
winter seldom fall in sufficient abundance to raise the rivers until the 
month of December, so that it is often not before Christmas that the 
steam-boats commence running. January, February, March, and 
April, are generally rainy months, though this year the latter month 
was extremely dry. 

It has been observed, that in very dry summers, the showers for 
the most part follow the direction of the rivers and larger creeks, so 
that whilst the land adjacent to the water-courses is in many instances 
drenched with rain, the upland and other places out of the main di* 



Heustis on the Climate of Alabama. 91 

rection of the streams are parched with drought. Whether this is to 
be explained by the mutual attraction subsisting between the more 
cool and humid atmosphere of such situations, as caused by local ex- 
halation, and the rain-bearing clouds, or by the state of electricity as 
influenced by such exhalation, I am unable to say, but that an at- 
traction of some kind actually exists, would appear to be satisfacto- 
rily proved by the circumstances above stated. 

At present, September 9th, a very extensive drought prevails 
throughout every portion of the southern and western states, as far 
as heard from, viz. Ohio, Kentucky, Tennessee, Arkansas, North 
and South Carolinas, Georgia, Mississippi, Louisiana, and Alabama. 
In Georgia it has been particularly severe, the crops having been cut 
short more than one-half. The same is also the case with many parts of 
this state remote from the water-courses. Other situations have been 
more favoured; but it is now more than a month since the ground 
here has been wet with rain, and in other parts of the country there 
have fallen but one or two showers in the course of three months; ve- 
getation of all kinds is fast drying up, the fruit upon the trees is 
shrunk and shrivelled, and the leaves dying and falling prematurely: 
many trees of the forest, especially in sandy soil, are actually dead: 
in short, to use a figure of sacred writ, "the earth is turned into 
iron, and the heavens into brass." 

Since writing the preceding, the country has been favoured with 
partial showers; though the ground is so excessively dry, that a 
week's rain would scarcely penetrate to the moist earth. 

This country is very subject to high winds and tornadoes, which 
are generally accompanied with rain, rendering them more danger- 
ous and destructive. At sundry times within the last year, this vi- 
cinity has been thus visited, to the great inconvenience and damage 
of the farmer, whose plantation thereby is often strewed and cover- 
ed with dead trees, his crop in a greater or less degree destroyed, 
his fences blosvn down, horses and cattle killed, or perhaps his houses 
and cribs razed to the ground, and the whole fruits of his year's la- 
bour scattered before the wind. Such instances of overwhelming 
destruction are not very frequent; though one occurred last Novem- 
ber, in a tornado which passed about twenty miles below this place: 
it was from a hundred and fifty yards to a quarter of a mile wide, 
and of uncertain extent, perhaps four or five miles long; diminishing 
gradually in severity as it progressed. Before it trees were as stub- 
ble, and houses and their contents as chaff'. Owing, however, to its 
limited extent, and the sparce population, no human lives were lost 
Hail storms, accompanied with much thunder and lightning, fre- 



92 Heustis on the Climate of Alabama* 

quently happen in the months of March, April, May, and June. One 
occurred in Tuscaloosa in the latter part of March, 1829, which 
ruined all the gardens, and destroyed every leaf of vegetation; leav- 
ing the hail in many places, as it drifted, several feet in depth, a bar- 
rel of which, as a curiosity, was put on board a steam boat and taken 
to Mobile. On several occasions, in the spring of the year, I have 
seen the trees of the forest entirely stripped of their leaves by the 
hail, and the earth covered several inches in depth with the offen- 
sive putrefying foliage. A storm of this kind occurred in the vi- 
cinity of this place, during an extensive shower on the 2d of July; 
the hail left upon the ground was three or four inches in depth, 
and was to be seen the next day. It w r as principally limited to three 
or four plantations. 

Generally, the hottest weather occurs in June, though the months 
of July and August are very sultry and oppressive. During the 
three summer months the system is much relaxed and debilitated. 
This effect of the weather is here, as in more northern climates, 
more remarkably exemplified among children and teething infants, 
who are at this period very liable to cholera infantum, and chronic 
diarrhoea, or as they are usually termed, bowel complaints. These, 
though often obstinate, are not generally, or even often, fatal: as out 
of a number of cases this season, I have not lost a single one from 
this disorder; and frequently having to prescribe under the disad- 
vantage of not seeing the patient. This affection is frequently com- 
plicated with worms, for which as well as to answer the purpose of 
an alterative, I prescribe calomel in small doses, say, one, two, or 
three grains every night, for two or three nights in succession; and 
three or four grains of Dover's powder, repeated every night at bed 
time; a dose of castor oil once or twice a week; sometimes substi- 
tuting, as a mild purgative, with the best effects, rhubarb and mag- 
nesia. Should there be any tenesmus, or dysenteric symptoms, ex- 
hibiting at night, after the operation of the purgative, an anodyne 
enema, consisting of starch, warm w 7 ater, and eight, ten, or twelve 
drops of laudanum to children a year or two old. As an anthelmin- 
tic I prescribe, almost indifferently, oil of wormseed, (Artemesia 
satonica,) Spigelia, or a decoction of the bark of the Melia azeder- 
ach; the two latter require to be exhibited with caution, as I have 
known the sight sometimes impaired by them, and even complete 
amaurosis result from the free use of the decoction. Of the decoction 
or infusion, made moderately strong, I direct a wine glassful to be 
taken twice a-day, for two days, then omitting its use a day or two, 
and again resuming it should it be necessary. 



Heustis on the Climate of Alabama. 93 

Sudden changes in the weather, during the summer, from hot to 
cool, are unfavourable to health; giving rise to various degrees of 
what are called colds, and in children, an affection of the mucous 
membrane of the bowels, showing itself in cholera, diarrhoea, and 
dysentery. Adult invalids, and persons convalescent from preced- 
ing sickness, are also affected by these complaints. This is more 
especially the case, at the approach of the cool weather of autumn; 
those who have suffered attacks of bilious fever being then especially 
liable to relapses, under the form of ague and fever, or as it is com- 
monly called, chill and fever. In proportion as the inhabitants have 
become acclimated, disease has greatly subsided; insomuch that 
the probability is, that at this time, there are few more healthy 
states in the Union. The so much dreaded yellow fever of our sea- 
ports, now that its character and treatment are better understood, 
ceases to inspire terror; nor is the interior of our state now visited 
with the bilious fever, except in a few detached points of peculiarly 
unhealthy location, or in a few sporadic instances of unacclimated 
subjects,* and even in those it is rarely obstinate or dangerous, ex- 
cept from improper treatment. 

For the three first years after my arrival in this state, in 1821, 
1822, and 1823, the country was dreadfully sickly, and the mortality 
great and appalling, more especially near the rivers. The whole 
country was then new, and the warmth and humidity of the seasons 
caused a great and rapid decomposition in the recently exposed and 
turned up vegetable matters. Many flourishing towns upon the 

* During- the present summer, August 11th, I was called to visit some pa- 
tients at Canton, a small town on the Alabama, twenty-five miles below this 
place. There were there a number of aggravated cases of bilious fever, some 
two or three of which terminated fatally; yet almost every other part of the 
country has proved quite healthy, at least as far as the fever has been concern- 
ed. The local aspect of the above-mentioned place, at the first glance, would 
appear healthy, being very high, and the soil sandy. Contrary to the observa- 
tions of some physicians, I have generally found, that towns and settlements 
upon sandy soil, were more subject to bilious fever, than others where the sur- 
face was stiff and tenacious, from an over-proportion and admixture of clay. 
For this I can only account in this way, that the sandy soil becomes more heat- 
ed, and, therefore, gives rise to a more copious extrication of miasmata. The 
town of Canton is situated on a very high bluff, but the place is much overrun 
with tall weeds, bushes, and shrubbery of various kinds, covering the earth 
with the litter of decaying leaves, and other vegetable matters, and retaining 
the water that falls in rains. It has, moreover, been found, that very high 
bluffs, in the immediate vicinity of low grounds, are more subject to disease 
than others that are less elevated. 

9* 



94 Vaughan's Medical Cases. 

rivers, which had risen up, as it were, by the hand of enchantment, 
received a sudden check, and became suddenly almost totally aban- 
doned, from death and desertion. Strangers from every part of the 
United States, invited by the fertility of the soil, the beauty of the 
country, and the serenity of the climate, brought together by for- 
tuitous association, with foreign and unseasoned constitutions, were 
suddenly swept off by thousands. In many families there were not 
well persons sufficient to attend upon the sick and dying. Never have 
I known a time of such general calamity. There was then no "t em ~ 
pering of the wind to the shorn lamb," but age and infancy were 
alike hurried to the grave; Rachael was not even spared to weep for 
her children, but fell an indiscriminate sacrifice before the destroying 
angel. From this severe visitation many places have not yet recover- 
ed: and as the population of the state since then has augmented three- 
fold, we can form some notion of the vast natural advantages and in- 
ducements held out to emigrants, who, in such numbers, could brave 
all the terrors of a country that to many had proved so uncongenial 
and fatal. But these times are happily passed; and we can now look 
back upon this melancholy period of our history, like the shipwreck- 
ed mariner who stands upon the sunny shore, and contemplates with 
mingled emotions of joy, gratitude, and sorrow, the danger and de- 
struction which he has escaped. 

As there is a very considerable proportion of cool and variable 
weather during our winter months, the diseases of this season, though 
less numerous, resemble those of northern climates, being mostly of 
an inflammatory character; among which the most common are pleu- 
risies and inflammations of the lungs. Ophthalmia and rheumatic 
affections are also frequent. But it is unnecessary to go into a par- 
ticular enumeration and detail, as the diseases incidental to other 
climates, with certain limitations and exceptions, already hinted at, 
are also common here. 

Cahaba, Alabama, 1831. 



Art. VIII. Medical Cases. By J. Franklin Vaughan, M. D. 
Physician to the Alms-house of New Castle County, at Wilming- 
ton, Delaware. 

v^ASE I. — Hepatic and splenic derangement, simulating organic dis- 
ease of the heart or aneurism of the aorta. — A married lady; who had 
generally enjoyed good health, and was the mother of several fine 



Vaughan*s Medical Cases, 95 

children, was attacked in the latter part of July, 1825, with bilious 
fever, then prevalent in the district in which she resided. The at- 
tack being violent, and-tlte fever of. a highly inflammatory type, her 
physician, (as he informed me,) had to resort to active and decisive 
measures for relief, s Depletion free and repeated, by the lancet, ac- 
tive purging, and all the usual antiphlogistic means were put in re- 
quisition. In the course of a short time the fever yielded, tonics 
were prescribed, the patient pronounced convalescent, and medical 
attendance discontinued. 

In about six weeks, however, the doctor was summoned to visit his 
patient in haste, as she was " dangerously ill. " He found her labour- 
ing under an urgent sense of suffocation, violent palpitation of, and a 
most distressing feeling of weight about the heart, with acute pain. 
Venesection was at once resorted to, and some relief afforded, but 
the pain in the region of the heart and the palpitation continued. A 
consultation with an aged and respectable practitioner was held, and 
her disease was pronounced to be either, (which, they found it impos- 
sible to ascertain,) "an organic affection of the heart, or an aneurism 
of the aorta at its arch. " Under these circumstances, a palliative 
course was adopted, consisting of venesection once or twice a week? 
according to the violence of the symptoms, with digitalis, absolute 
rest, low diet, anodynes at night, &c. This plan was continued for 
near two months, without any alleviation of the distressing symp- 
toms, but, on the contrary, (as the patient stated,) they were all 
greatly aggravated, when I was called to see her. 

Her situation at this time was truly deplorable; the palpitation of 
the heart was so violent as to throw up the bed-clothes, (at every di- 
astole,) so as to be distinctly seen across a large room! and the men- 
tal despondency was greater than I had ever seen it, despair seeming 
literally stamped upon the features. This' state of mind, however, 
I was not much surprised at, when J learned ,from the lady that she 
had been made acquainted with the fearful diagnosis and still more 
terrible prognostic — a sudden death. The patient was, as might be 
expected, very much debilitated; her skin was sallow and unhealthy? 
the bowels torpid, being evacuated only by medicine, and the pulse 
wiry or corded, quick and frequent. 

After a minute enquiry into the history of the case, and a most careful 
examination of the thorax, both by mediate and immediate ausculta- 
tion, I was induced to believe that there was really no primary or 
permanent disease of either heart or aorta. Some other cause for 
the situation of the patient was then to be sought for, and my atten- 
tion was immediately directed, (by the history of the case and the 



96 Vaughan's Medical Cases. 

generally depraved state of the system,) to the chylopoietic apparatus; 
and here I soon found a state of things which confirmed the opinion 
already expressed— a very great enlargement and induration of the 
spleen, some enlargement, evident induration, and slight tenderness 
on pressure in the liver, and the usual debility and disorder of sto- 
mach consequent to biliary obstruction. 

Might not then all her sufferings be referred to the derangement 
of the functions of these important organs, and all the indications of 
disease in the thorax be sympathetic and delusive? 

In the subsequent consultation, this opinion was looked upon, (by 
those in attendance previously,) as fanciful or " speculative;" and the 
indications, or methodus medendi predicated upon it, positively con- 
demned as being utterly inadequate to relieve the urgent and alarm- 
ing symptoms, and only calculated to hasten the termination of an 
incurable disease! On, however, fairly, plainly, and explicitly stating 
the case in the presence of all concerned, my opinion, and the treat- 
ment founded upon it were adopted — because it offered some hope, 
the other none. 

The course pursued may be related in a few words. A very 
slight salivation was excited by the blue pill, and maintained for 
about four weeks; an epispastic applied over the liver and spleen, 
dressed, (as soon as it could be borne,) by the ungt. mere, alight but 
more nutritious diet was allowed, and cheerful society, &c. &c. re- 
commended. Soon after a gentle ptyalism was established, the ob- 
structed secretions were restored, the torpid bowels became regular, 
and the enlargement of the liver and spleen were found to be yield- 
ing to it and the counter-irritants; a perceptible diminution in the 
violence of the palpitation, with relief of pain, weight, oppression, 
&c. directly followed, and the general health gradually and regu- 
larly improved, until a complete restoration was effected. During 
the convalescence, tonics, (especially cort. peruv. withrad. valerian.) 
were freely administered, aided by a nutritious diet, and as soon as 
the strength was sufficiently increased, active exercise, especially 
riding, &c. &c. Five years have now elapsed, and this lady conti- 
nues perfectly well. 

The preceding case suggests several remarks — but leaving others 
to draw their own inferences, I will only notice two, which appear 
to me of practical importance. In the first place, the only difficulty 
was in making a correct diagnosis, and yet the most efficient aid in 
forming it — auscultation—was entirely overlooked, and the idea that 
it really afforded any important information, was treated with deri- 
sion! and this by respectable (though certainly mere routine) coun- 



Vaughan's Medical Cases. 97 

try practitioners. Jam solvi nobile problema — dato aliquo morbo, 
invenire remedium? Every one will admit the truth of this proposi- 
tion — but the difficulty lies in the dato morbo, (the disease, not its 
name, being given,) which is, very frequently indeed, not the fact. 
The tissue affected, the nature and degree of its morbid lesion, or 
even the organ, or more than this, even the cavity in which the dis- 
ease is located, are often involved in great obscurity. — I have al- 
ways considered the diagnosis as the great difficulty in the practice 
of medicine; and, therefore, value, above all others, those works and 
those means which are calculated to throw any light upon a subject 
of such vital importance. Is it not then unpardonable in a practising 
physician to neglect any of those means, and especially when of 
such established utility as the stethescope? 

2d. The state of the pulse, and the appearance of the blood de- 
tracted in this case, are worthy of notice and comment. The former 
was* frequent, corded, and tense; and the latter buffy and cupped — 
up to the period of my first visit; and these facts were confidently 
insisted on, not only in justification of the repeated bleedings, but 
as absolutely demanding their continuance. My views, however, 
were very different — I had seen this same synocula pulse, small,, 
corded, frequent and tense, exist in a state of alarming debility — 
had witnessed its removal by the use of tonics and a nourishing diet, 
and had been fully convinced, that repeated bleeding might and 
would produce it — but never can, never did, remove it. 

Accurately to discriminate between the irritable and the inflam- 
matory pulse, though at all times of the utmost consequence, is ? 
occasionally, exceedingly difficult. My excellent friend, and, for 
some time, preceptor — the distinguished Dr. Parrish— used to re- 
late the following interesting example, in his lectures: — While Dr» 
Wistar was in Edinburgh, he with some other students, one day bled 
a dog to death. Just before he expired, a practitioner, (who was well 
accustomed to feeling the pulse,) happening to stepin, was requested 
to place his hand on the dog's heart, (being unacquainted with what 
had been done,) and inform them whether the action was sthenic or 
asthenic? He made the desired examination, and pronounced the 
excitement to be- — sthenic! 

This synocula pulse is frequently met with in the advanced stages 
of phthisis pulmonalis, accompanied by great prostration of strength; 
and also occurs, occasionally, in hectic fever^ proceeding from dis- 
eased bones, old, indolent, and sloughing ulcers — where it is merely 
the effect of irritation. Sometimes, indeed, it may be found just before 
dissolution — appearing to be only the last struggle of expiring nature. 
Concerning the indications to be drawn from the appearances of 



98 Vaughan's Medical Cases. 

the blood, Sir Astley Cooper gives us a valuable lesson, or caution,, 
in the following case: — a man, (in Guy's hospital,) in the last stage of 
scurvy, whose skin would ecchymosefrom the slightest pressure, and 
from whose gums blood was oozing, was bled, (a little being taken 
as an experiment,) and, even here, the blood was both sizy and cupped! 

Case II. — Ascites and anasarca, from enlarged spleen. — John H. 
a labourer from the Chesapeake and Delaware Canal, was admit- 
ted into the Alms-house on the 15th of November last. He stated 
that he had been labouring under " fever and ague for four months, 
had a very large and hard ague cake in his left side, for about three 
months, and had been swelling gradually, for six or seven weeks 
past." At the time of his admission he had a severe chill every 
evening — discharged blood from the bowels, and the accumulation of 
water was so great, as to confine him entirely to bed. The enlarged 
spleen, (as hard as a board, to the touch,) filled the whole of the left hy- 
pochondriac, iliac, and inguinal regions, extending down almost in 
contact with the os pubis, and across the epigastric and far into the 
right iliac and inguinal regions. Its size was, indeed, almost incre- 
dible. The abdomen was distended with water — the feet and legs 
swelled almost to burstings the countenance sallow, pulse feeble and 
frequent, skin dry and harsh. 

Mercury being evidently demanded, it was at once had re- 
course to. A pill of calomel and opium, aa. gr. ss. with squills,, 
gr. ij. was given three times a day; with tinct. digitalis, gtt. xv. 
gradually increased to gtt. xl. immediately after each pill. And 
he was rubbed, mane et vespere, with ungt. mere. In three 
days, a gentle ptyalism was excited — the chills ceased almost im- 
mediately — copious discharges of urine soon succeeded, and in 
about ten days all dropsical swelling was gone. The morbid con- 
dition of the spleen was not, however, materially improved, and 
the patient could not be considered safe whilst the cause of his 
dropsy remained. The inefficiency of mercury, in many old cases 
of enlarged spleen, has long been known, and a remedy, on which 
more dependance might be placed, ardently desired. This, I trust, 
has at length been found in iodine and its preparations. In this case, 
gtt. xij. of a saturated tincture, gradually increased to gtt. 1. ter in 
die, and continued in that dose, until the head and stomach became 
slightly affected — with the following ointment well rubbed in over 
the tumefaction, morning and evening, in about four weeks reduced the 
spleen to its natural size and healthy functions, (whatever they may 
be.) R. ungt. mere. §ss., hydriod. potass. 9ij., liq. potass, gtt. vi. 
M. ft. ungt. — One half of which was rubbed in daily. It may be 



Vaughan's Medical Cases. 99 

proper to add, that the chalybeate tonics were given to complete the 
cure. 

The preceding case is related chiefly with a view to make a few 
brief observations on the treatment of dropsy, and to afford additional 
testimony in favour of the effects of iodine in enlarged glands, or 
visceral obstructions — a troublesome and sometimes intractable kind 
of casesi 

1. The diuretic combination used in this case, (viz. calomel, squills 
and digitalis,) has been condemned by a very respectable writer, 
Blackall; and some practitioners may, on his authority, have dis- 
continued its use. But I can conscientiously declare, that in no 
disease have I seen any medicine display more decidedly beneficial 
effects than this combination does in dropsy. I could relate many 
cases in which it produced the same happy result as in the preceding; 
but will mention only one, now under my care, in which the patient 
was cured by it, two years since — recently exposure and intem- 
perance brought on diseased liver and its consequence, dropsy; and 
again is he rapidly recovering under the use of the same medicines. 
In reply, then, to any speculative objections against a combination 
or prescription of fully ascertained value, I have only to say that what 
I have related are facts — and that facts are stubborn things; that they 
will not, nor can they be made to bow submissive before theory, no 
matter how high may be the source from whence it emanates. If the 
answer, "experientia docet, 77 can be truly made to any hypothetical 
doctrine or opinion, it is not conclusive? I should add, before termi- 
nating my remarks on the treatment of dropsy, that I prefer the 
calomel and squills, in pill, (with or without opium, according to 
circumstances,) and the digitalis in tincture; for, by exhibiting them 
in this form, the latter can be gradually increased or diminished, pro 
re nata, while the pills may remain unaltered; and often, the mouth 
becoming sore, it is proper to discontinue the pills, when the digitalis 
ought not to be omitted, indeed cannot, with propriety, be dispensed 
with. 

2. Of iodine, I might mention, in addition to its decided effects in 
the preceding case, several others of enlarged spleen, the sequelas of 
intermittent fever entirely removed by it — as also a case of goitre ? 
and one of sarcocele, cured by the tincture internally, and the oint- 
ment above-mentioned, topically, in about four weeks time. But I 
will only relate one more instance of its triumph over disease. 

Case III. — Incipient Phthisis. — Mrs. M. a young widow lady, of 
a consumptive family, after labouring under amenorrhcea for three 



100 Joslin's Observations on Vision. 

months, was attacked with hemoptysis, succeeded by a troublesome, 
dry cough, and hectic fever. When she applied for medical aid, in 
addition to the symptoms mentioned, her skin was sallow, and her 
general health in a very depraved state, with a quick and frequent 
pulse, and great debility. 

Having seen, in some one of the medical journals, a statement that 
iodine had proved serviceable in a similar case, I concluded to give 
it a fair trial| and, consequently, directed gtt. xij. of a saturated 
tincture, (forty-eight grs. to the §j.) to be taken, ter die, increased 
daily a drop at each dose. It was continued with this gradual and 
regular increase of the dose, until gtt. lx. were taken three times a 
day. This quantity was persisted in for six days, no bad effects 
ensuing, when the menstrual discharge came on; the consumptive 
symptoms rapidly subsided, and the patient's health was soon restored. 

The following winter this lady " took cold whilst unwell," 
amenorrhoea was the consequence, with a return of the consump- 
tive symptoms, which were again removed in the same manner as 
before. No other medicine was used in this case, except sulph. 
sublim. or magnes. calc. to keep the bowels in a soluble condition. 

In conclusion, I think it proper to add, that I have never seen any 
injurious effects from the iodine, though used freely and frequently 
in both my public and private practice. 

Wilmington, Del Feb. 1831. 

Hi.-: 



i 

Art. IX. Observations on Vision. By Benjamin F. Joslin, M. D. 
Professor of Mathematics and Natural Philosophy in Union Col- 
lege, Schenectady, New York. 

ACCOMMODATION of the Eye to different distances.- -When the 
pupil of one of my eyes was dilated by stramonium for certain physi- 
ological experiments, (an account of which will be published hereafter,) 
some indistinctness of vision was experienced, which was found on 
examination to affect objects at moderate distances only. All objects 
in the room were somewhat obscure, whilst those situated without, 
at the distance of many rods, appeared equally distinct to both eyes. 
By placing in contact with the eye, and directly before the dilated 
pupil, an opaque plate, perforated with a circular aperture of nearly 
the same apparent magnitude* as the other pupil, there was no appre- 

• The incident and emergent rays undergo a similar refraction at the cornea. 



Joslin's Observations on Vision. 101 

ciabte difference in the distinctness of vision with the two eyes at any 
distance. It was, however, found necessary to employ different aper- 
tures for different distances, not only when the object was near the 
distance of distinct vision for minute objects, but at distances of 
many feet. The less the distance, the less was the requisite aper- 
ture; so that by employing artificial diaphragms of different aper- 
tures, the same distinctness of vision was obtained as with the eye 
in its natural state. This, however, was of course only true of direct 
vision; for in oblique vision, the lateral and too oblique rays of the 
pencil would not be thus excluded, and no artificial substitute can in 
that case be provided for the natural interior diaphragm, the iris, so 
happily imitated in the periscopic glasses of Dr. Wollaston. It is 
also probable that even in the case of very distant objects, there was 
a greater spherical aberration in the eye whose pupil was dilated, but 
that this was sensibly compensated by the stronger illumination re- 
sulting from a greater aperture. 

We are warranted in concluding from the foregoing experiments, 
that at least under some circumstances, there is a necessary corres- 
pondence between the virtual magnitude of the pupil, and the accom- 
modation of the eye to distinct vision at different distances — and also 
that the observed effect of the stramonium did not depend chiefly, if 
at all, on the paralysis of any other part concerned in the adaptation. 
Whether any change in the iris generally conduces to, or even at- 
tends this accommodation in ordinary vision, is a point upon which 
physiologists are not agreed. The foregoing experiment seems to fa- 
vour the affirmative. 

Notwithstanding the various unsatisfactory conjectures respecting 
the uses of the ciliary processes, and the no less numerous hypotheses 
respecting the adjustment of the eye to distinct vision, this last has 
perhaps never been attributed to a change of form in the crystalline, 
produced by the simultaneous action of the different parts of the ci- 
liary processes. An action producing lateral displacement has been 
supposed, which can effect no such adjustment, and is less likely to 
take place than a general contraction and dilatation, especially if we 
consider them as belonging to the erectile tissue. 

In the eyes of a horse killed in health, and examined immediately 
after death, I found the attachment of these processes to the capsule 
of the crystalline very strong. It appeared to require more than ten 
times as much force to detach one of them, as to break an equal por- 
tion of the fibres of the crystalline, on whose contraction Dr. Young 
supposed the adjustment to depend. In the human eye, however, 
the attachment is generally considered rather weak. It is perhaps 

No. XV.— May, 1831. 10 



] 02 Joslin's Observations on Vision. 

strong enough during life to produce some little effect, and it is not 
necessary to suppose the accommodation to depend exclusively on 
any single structure, nor that the different parts of the eye which 
may conspire to produce this effect, exercise the same relative influ- 
ence in different animals. The stronger attachment of the ciliary zone 
in some animals, may indicate, if not a different office, at least, a 
greater share in an office or function performed by the combined ac- 
tion of several parts, and by a different mechanism. I would hardly 
offer the above as a hypothesis, but merely state it for the consider* 
ation of physiologists. 

But whatever hypothesis may be correct, it appears to me that 
the necessity of some adjustment has never been disproved, either 
experimentally or theoretically* It is true, that eminent physio- 
logist, M. Majendie, found the image formed on the posterior part 
of the dead eye of an animal to be distinct, when the object was 
placed at different distances; and this experiment has been consider- 
ed irreconcileable with any theory of adaptation. But unless the an- 
gular magnitude of the object were very considerable, the image 
would be too minute to allow the irregularity to be perceived in such 
an experiment. For in this instance, the image which occasions our 
perception is the image of an image, and has nearly the same ratio to 
the primary image as the latter has to the object; so that it appears 
to me very possible, that the distinctness of the object might be sen- 
sibly affected by a change of distance, such as would not sensibly af- 
fect the regularity of its image formed at the bottom of a dead eye, 
and regarded as an object of vision. 

Theoretical arguments against accommodation are no less incon- 
clusive. They have, so far as I have seen, overlooked the necessity 
of concentrating, upon a single point of the retina, the rays emanat- 
ing from a single point of the object, and the constancy of their an- 
gles necessary for this effect. The difficulty is not removed, as has 
been supposed, by calling the eye a camera obscura; for this instru- 
ment also, when provided with a lens, requires adjustment to dis- 
tance; and the reason why it may seem to "show objects distinctly 
for many miles round,"* appears to me to be, that at great distances^ 
a given difference of distance produces a less difference in the obli- 
quity of the rays, than an equal difference of distance in near objects. 
With objects at small distances, the defect would become instantly 
manifest. But on the other hand, adjust the instrument to near ob- 
jects, and it would be of no avail that " an infinity of other rays flow 
from a distant object in all directions,"* unless those which flow 

* See M. Majendie's Physiology* 



Joslin's Observations on Vision, 103 

from a single point, make with each other and with the cornea the 
same mean angles as those from a single point of a near object — which 
is impossible. 

Moreover, the removal of a portion of the humours of the eye, or 
of the iris, dilates the image, by preventing the concentration of any 
pencil on a single point of the retina. The same effect is produced 
by any change in the requisite length of the axis. Hence the great 
extent of the vitreous humour is not only of " use to extend the field 
of vision,"* but is indispensable to the removal of the sentient screen 
to the precise distance at which the image is most perfect. This is a 
point which is not sufficiently appreciated by many plAsiologists, 
who speak vaguely also of the other humours, as merel^' increas- 
ing the intensity of the light."* 

In short, any change in the distance of the object, the refracting 
power of the eye, or the length of its axis, must produce a change in 
distinctness, unless a simultaneous change in two or more of these 
circumstances effects a compensation. 

Now, different single parts, which by various physiologists and 
philosophers have been shown to effect this compensation, have by 
others been respectively either removed or placed in circumstances 
which nullified their influence, and yet the powers of compensation 
remained. These apparently contradictory results are reconciled by, 
and seem to require a less simple hypothesis. Such an hypothesis 
would be perfectly consistent with the rule of philosophizing, causas 
rerum naturalium non plures admitti debere, quam quae et verae sint, 
et earum phaenomenis explicandis sufficiant; for more than one single 
cause has been proved to exist, yet no one of them has been proved 
fully adequate. 

From some of the foregoing considerations, we might be induced 
to suspect that night reading, or any employment which requires the 
examination of minute and near objects with a faint light, and con- 
sequently during the expanded state of the pupil, has a tendency to 
produce myopia, or short-sightedness. For, during the obscurity of 
evening, the dilatation of the pupil necessarily resulting from the in- 
voluntary sympathy between the retina and iris is unfavourable to 
the distinct vision of near objects; but we nevertheless make an ef- 
fort to see distinctly; an effort which may put in requisition to an 
extraordinary degree the voluntary powers of accommodation; and 
those parts in which these powers reside, and those upon which they 
directly operate may become permanently changed in their action 
and conformation, in consequence of a reiterated action in the former 

* See M. Majendie's Physiology. 



104 Joslin's Observations on Vision. 

to a greater extent than is necessary during the light of day, when 
they enjoy in a higher degree the cooperation of the iris. 

Appearance of the Tears on the Cornea. — Of all the proper ob- 
jects of vision, (i. e. those exterior to the eye,) I have for many 
years believed that I had seen one of the nearest which could ever 
be visible to the eye of any animal ; that is, the fluid secreted by the 
lachrymal gland, and rendered visible by the light refracted at its 
undulated surface, as it flows down the anterior surface of the cor- 
nea. This fluid contains visible spherical particles, or is mixed 
with some, partly perhaps from the meibomean glands. My experi- 
ments majfbe repeated in the following manner. 

If any person, with his eyelids nearly closed, looks toward a win- 
dow, or any luminous object nearly stationary, the luminous space 
will appear to be filled with circular bright spots, surrounded by 
dark rings. Some of these circles are much larger than others, and 
are either single, double, or multiple. An undulated appearance 
is frequently presented, each wave being either continuous, or com- 
posed of, or containing a chain of spherules. All these objects move 
slowly downwards in a vertical direction. That this motion depends 
on gravity, I assured myself, by giving to the head various inclina- 
tions, and finding the general direction of the motion still vertical as 
before. I say the general direction, for in whatever position the 
head is placed, there are occasional instantaneous motions through 
very short spaces, such as would be produced by slight involuntary 
relative motions of the eyelid and eyeball, impressing on that part 
of the fluid contiguous to the tarsus, a motion which would be ne- 
cessarily transmitted to the whole visible lamina, and produce in it 
a simultaneous displacement. That these slight motions are of this 
nature is verified by observation, for at any one time they agree in 
the instant of their commencement, in their direction, duration and 
extent, for all those objects of which we have been speaking. There 
are, however, other appearances which present themselves in the 
same field, but with which those just described, must not be con- 
founded. They are less distinct points, with rapid and irregular mo- 
tions, and resemble electric sparks. It is also necessary, in order 
to see no motions of the fluid on the cornea, except those which I 
have described, to guard the eye against voluntary motions, by direct- 
ing the optic axis as steadily as possible toward some fixed point in 
space. With these precautions in making the observation, each vi- 
sible portion of fluid will be seen finally to pass the inferior limit of 
the field of vision. This constant relation to the line of gravity in 
every position of the head, proves these objects to be some gravi- 



Joslin's Observations on Vision, 105 

tating matter. The perpetuity of the phenomenon in the erect pos- 
ture, forbids the supposition of its being in the humours; and the 
luminous centre and dark annulus of the circular spots, and the lu- 
minous middle and dark parallel sides of the linear ones, as well as 
the varieties in the appearance and number of the rings, (for more 
than one is frequently visible,) present the same appearances as per- 
fectly transparent fluid spherules and waves on the surface of the 
cornea might produce, agreeably to the laws which regulate the 
transmission of light through thin plates of variable thickness. Fi- 
nally, these appearances are more obvious, when from weakness of 
the eye or any other cause, the lachrymal secretion is more abundant. 

Hemiopsis. — I have twice experienced a partial insensibility of the 
retina, attended by some peculiarities not recorded in Dr. Wollas- 
ton's cases. At each time, objects and parts of objects, situated on 
the left side of the visual axis, were, for about half an hour, either 
indistinctly seen, or totally invisible; for instance, the left side of a 
printed page, of a line, and even of a single word, was not perceived 
whilst the eyes were directed to the middle. There was conse- 
quently an insensibility of the right half of each retina. In both 
cases, a glimmering zig-zag, or broken line, appeared to be situated 
before the eyes above and to the left of the point toward which their 
axis were at any time directed, and as near as could be determined, 
in that part of the field of vision which was most completely ob- 
scured. In the first case, this line had an angular appearance, being 
composed of two lines, (see figure,) meeting at an angle of about 60°. 
It moved very slowly upwards, and to the left, ^ 

and disappeared about the same time that per- ^-^^L-? 

feet vision was restored. In the second case, ^^ / 

the line resembled one of the branches of the ^-^ /— 

former, was, like it, composed of numerous -^ £y 

short lines, but its general course was nearly *\^ ^~7 

straight and horizontal. Its left extremity be- 
came gradually more and more elevated, and in this oblique position 
the imaginary object finally "disappeared. The whole space occupied 
by these objects, subtended a visual angle of about 20°. Their co- 
existence with the hemiopsis may be worth recording, as simi- 
lar observations may possibly throw some light on the pathology 
of both. It is well known that Dr. Wollaston has inferred from the 
latter a semi-decussation of the optic nerves. 

Schenectady, Dec* 1830. 

10* 



106 Young on the Gangrenous Sore Mouth of Children. 

Art. X.— Observations on the Gangrenous Sore Mouth of Children, 
By Jesse Young, M. D. of Chester, Penn. 

IN the medical journals of the day, I frequently see descriptions of 
a disease, under the different names of cancrum oris; gangrense 
oris; gangrenous sore mouth; humid gangrene of the lips; gangre- 
nous erosion of the cheeh fyc. fyc; but perhaps there cannot be a 
more practical name, or one that conveys a more accurate idea of its 
appearance, at least, than that applied to it by Dr. Parrish, viz. 
" A disease resembling the effects of mercury." From the descriptions 
given, or rather from the result of cases published, it appears to 
be very frequently fatal, under all the different modes of prac- 
tice resorted to by different practitioners; and that no means have 
been heretofore used, which have proved even generally successful, 
with the single exception of the sulphas cupri. This is said to have 
been particularly efficacious; and of the fact, there can be no just 
reason to doubt, from the number and respectability of the vouchers 
in its favour. To add one other article, which has been found pecu- 
liarly serviceable, and which has not been'publicly recommended, so far 
as my information extends, is the object of the present communication. 
In June, 1824, a length of time before I knew of the sulphas 
cupri having been recommended, and before I had ever seen the 
disease, I was requested to visit the son of J. W., aged four 
years and two or three months, with a sore mouth, which the pa- 
rents had been endeavouring to combat for about a week, with do- 
mestic remedies; but in spite of their efforts, it continued to grow 
worse. On visiting him, it was with difficulty I could be convinced 
that the child was not labouring under a severe mercurial saliva- 
tion; there being several sores in the roof of the mouth, and in 
the cheeks, which had exactly the appearance of mercurial sores; 
the saliva flowed constantly from his mouth, and his breath exhaled 
an abominably fetid odour. On being assured that he had taken no 
mercury by their instigation; and that it was impossible for him to 
have obtained it without their knowledge, I gave up the idea of mer- 
cury having produced it, and concluded, that it must depend on 
some peculiarly unfavourable state of the stomach and intestinal canal. 
I accordingly prescribed an emetic of ipecac, followed by four grains 
of calomel, to be succeeded in three hours by oleum ricini, so as to 
operate actively on the bowels; using a gargle, or wash for the mouth, 
of sage tea, alum, and honey. On calling next day, the symptoms 
were no more favourable in any respect; a slow, irritative fever, of a 



Young on the Gangrenous Sore Mouth of Children. 107 

remitting character, which had been noticed before my attention was 
called to the case, appeared rather to increase than otherwise, al- 
though the medicine yesterday operated freely. During the opera- 
tion of the cathartic, the evacuations were dark-green, and very of- 
fensive — ordered charcoal and magnesia in equal portions, a tea- 
spoonful every four hours, and tincture of myrrh as a local applica- 
tion to the sores. Next morning found the mouth worse than before; 
it was now very much swelled, the sores enlarged; the fever increas- 
ing with a circumscribed redness on the right cheek, the left pale; 
the pulse small, frequent, and irritable; the breath excessively offen- 
sive. The bowels have been moved three times pretty freely, dis- 
charges still green and offensive. Continued the magnesia and char- 
coal, and added sulphas zinci to the tincture of myrrh as a gargle. 

June 15th. Two of the larger sores on the palate look greenish? 
and one on the cheek has the same hue; the patient pale and lan- 
guid, bowels relaxed, but the evacuations are more favourable in 
appearance and odour. Requested tar water to be used as a wash 
at intervals, between the application of the tinct. of myrrh and sul- 
phate of zinc, and to omit the magnesia and charcoal. 

16th. The sores look darker than yesterday, and I began seriously 
to apprehend a fatal result; particularly so, as I heard this morning 
of the death of a child in the neighbourhood, from what was said to 
be the same disease. Almost in despair of curing, I now ordered a 
gargle, or wash, of eight grains of deuto -chloride of mercury, in an ounce 
of water, the sores to be cautiously but accurately touched three times 
a day, by means of a swab; and a table-spoonful of the decoction of cork 
Peruv. every four hours, to be commenced after moving the bowels 
with castor oil. From this day the patient began to mend, and by 
the 20th all the sores had sloughed; some of the smaller ones had healed 
up entirely, and the large ones had a florid, healthy appearance* 
The solution was now discontinued, and the mouth was frequently 
washed with mucilage of the slippery elm, (Ulmus Americana,) con- 
tinuing the decoction of bark; and on the 24th of the month I dis- 
missed the patient, all the sores nearly healed. Two of the children 
in the same family were subsequently attacked, but there was not 
the least difficulty found in curing them; commencing at once with 
the mercurial solution, after evacuating the first passages by an emetic 
and cathartic of calomel and castor oil. 

This was decidedly the worst case of the kind I have ever met 
with, which I attribute in a great measure to the delay occasioned by 
the use of inefficient means in the beginning. 

It has not been my lot to have had a very extensive experience 



108 Young on the Gangrenous Sore Mouth of Children. 

in treating the disease, but since the above, I have seen about 
thirteen cases, (here I would be understood as distinguishing be- 
tween the disease in question, and the aphthous sore mouths of 
children, so common, and which mothers generally manage them- 
selves,) in every one of which, an emetic of ipecacuanha, mostly 
followed by a cathartic, sometimes of calomel, and frequently of castor 
oil alone, or of magnesia, were exhibited at firsts these were followed 
by the decoction of bark and the solution of corrosive sublimate, varied 
in strength from two or three, to eight or ten grains to the ounce, ac- 
cording to the circumstances of the case, and the sensibility of the 
sores to its impression. My success by these means has been so 
prompt and complete, that I have not tried any other article since 
first using these. That there may occur cases in which their control- 
ling power may not prove so availing as I have found it, I can scarcely 
entertain a doubt; but I must say, that I have not in any one instance 
been disappointed in my expectations; but that every case in which 
they have been used, appeared to improve from the very commence- 
ment of the treatment. 

When I first used it, I was not. aware of its ever having been em- 
ployed before in the affection; but since, in conversation with my friend 
and preceptor, Dr. Gideon Humphrey, on the subject, he informs me 
that he has been in the habit of using it for years; his formula is tr. 
myrrh, §j. ; deuto-chloride mere. grs. iv. to vj. to be applied three 
times a-day, reducing the strength pro re nata, by the addition of 
water. His experience has been extensive, and his success uniform, 
and he assures me that he meets the disease with as little concern, 
and a much greater certainty of curing it than he does many other of 
the less serious affections of children. 

It may not be improper to observe, that all the cases which have 
fallen under my observation have occurred in children between two 
and five years of age; that the district of country in which they oc- 
curred was hilly upland, three to five or six miles distance from 
marshes, but that a majority of them occurred during the summers 
and autumns from 1824 to 1828 inclusive, a period at which remit- 
ting and intermitting fevers were very prevalent, although I do not 
recollect the disease in question having appeared in any case as a 
sequel to, or having been preceded by an attack of autumnal fever. 

Chester, Pa. Jan. 15, 1831. 



109 



MEDICAL EDUCATION AND INSTITUTIONS. 

Art XL An Account of the Origin, Progress, and present state of 
the Medical School of Paris. 

± HE medical school of Paris is, without doubt, one of the most an- 
cient in Europe. The precise date of its foundation is still, however, 
a matter of dispute among antiquaries; some affirming that it may be 
traced to a period anterior to the establishment of the university of 
that city, or of the different schools which subsequently received the 
form and charter of an university; whilst others maintain, that medi- 
cine was not taught as early at Paris as at Montpellier, and conse- 
quently not until long after the time assigned by the former writers, 
Although it does not comport with the plan of this article to enter 
very fully on this historical point, yet we may be allowed to remark ? 
that from various documents at present before us, and from several 
old writers upon this subject, it appears, that Charlemagne, in an 
edict dated from Thionville, so early as 805, ordered that pupils 
should be sent to Paris from various parts of his kingdom to study 
medicine, and that this branch should be added to grammar, arithmetic^ 
music, dialectics, rhetoric, geometry, and astronomy, which before 
constituted the only ones taught in the schools he had already es- 
tablished at Lyons, Metz, Fulde, Hirshau, Reichenau, and Osna- 
bruck. Riolan, in a singular little volume on the two schools of 
Paris and Montpellier, quotes in proof of the greater antiquity of the 
former, the writings of Hemerus, (Be Academia Parisiensi,) who 
says that at a very early period " physicians taught in a house 
situated in the square of Notre Dame, between the Hotel Dieu and 
the Bishop's house." In addition to this, he remarks that Rigordus? 
first Physician to Philip II. in his history of that monarch, says that 
in his time the physicians of Paris, taught fully and perfectly all 
the branches of medicine. The following remarks deserve to be 
quoted in the original. So early as the year 1163, "les medecins 
enseignoient avec un tel ravissement et contentement des auditeurSj 
que les religieux sortoient de leurs convens pour venir entendre les 
lecons; ce qui obligea le Pape Alexandre III., en un Concile tenu a 
Tours, de commander aux religieux, sur peine d'excommunication^ 
de se retirer dans leur monasteres avec defense de ne plus aller aux 
lecons des physiciens; ainsi appeloient ils les medecins* J? 



110 Medical School of Paris. 

In his historical sketch of the faculty of Paris, Hazon does not assign 
to this school so ancient an origin as others, as we have seen, have 
done; for, after remarking that it was naturally comprised in the as- 
sociation of savans, who, after their emigration from the monastic 
cloisters, and particularly from the episcopal one, assembled, each for 
his particular object or branch, under the name of study of Paris, he 
adds, " Before this fortunate revolution, which took place towards 
the middle of the twelfth century, medicine in France was nothing 
more than a blind empiricism. Under these circumstances the phy- 
sicians who united in the study of Paris, and were there formed into 
companies, commenced teaching the various branches of their profes- 
sion in that city. " 

Be the antiquity of the school of Paris, however, what it may, 
medicine, considered in its practical application, and as a branch of 
instruction, was before this period, in France, as in the rest of Eu- 
rope, confined to the monasteries. The monks of the Abbey of St. 
Victor, practised we are told, the principles of the healing art, long 
before France had emerged from a state of barbarism. The com- 
raandery of the Petit St. Jlntoine, whose hospitable monks devoted 
themselves to the treatment of epidemical diseases, may also be cited 
as a nursery of medical instruction. But these monasteries in cul- 
tivating the medical science, only preserved the ancient apanage 
of all monasteries; the healing art being in all practised with suc- 
cess,* and considered an act of piety and charity, and as a duty at- 
tached to the religious profession. The school of Salerno, indeed, 
founded by the Benedictines, only revived the science of medicine, 
which had become lost amid the confusion of the dark ages. Before 
the establishment of this school the medical art was only the results 
of chance, and of the experiments of a blind empiricism. At that 
time no physician could bleed a female of noble birth, except in the 
presence of a relation, or of servants, under penalty of ten sous. 
The physician was obliged to give security before undertaking a 
cure, and if he did not succeed he was condemned to damages and 
interest. For a long while kings chose their physicians only from 
among the inmates of the cloisters. Even by the immediate pre- 
decessors of Charlemagne, education was much neglected. The 
princes of that period had, it is believed, schools established in their 
palaces for the instruction of the young nobility; but this plan was 
not sufficiently general and regular. The great monarch afore-men- 

* Hodoaw. Chr. Rec. des Hist, de France, vol. 8, p. 229. Leboeuf. Hist, de 
la ville et du Diocese de Paris 3 vol. 2» 



Medical School of Paris. Ill 

tionedj established a system of education better calculated to diffuse 
instruction through the various classes of society; but the duties 
of teaching continued as formerly to be retained by the members of 
the clergy. The consequence was that a much greater importance 
was given to theology than to some of the more useful branches; a 
plan indeed which accorded well with the taste of Charlemagne, and 
was therefore encouraged by him. As physicians and philanthropists, 
however, we should not contemn the system he so zealously enforced; 
since the edict to which we have already alluded shows the impor- 
tance he attached to professional knowledge, and the desire he felt 
of propagating the study of medicine. In the twelfth century the 
savans of Paris, formed the determination of constituting themselves 
into an association, and obtained permission that the schools incor- 
porated in the manner above noticed, should assume the rank of, 
and be chartered as a regular university. The precise period of this 
reorganization is not known; but we are told by Mathieu Paris, 
that Jean de la Belle, who was elected abbe of St. Alban, in 1195, 
was educated at Paris, and had been associated to the body of 
Masters-— ad electorum consortium magistorium. 

Soon after this epoch the university was placed under the charge 
of a chief, mention of whom is made in an ordinance issued by 
Philip Augustus in 1200. By the same ordinance the university 
was endowed with many privileges and prerogatives. The studies 
were now conducted on a more regular and systematic plan, and in- 
stead of theology and the arts being the sole objects of interest, me- 
dicine began to assume the form of a science, and to be taught by re- 
gular professors. It was about this time that the faculties, in the 
sense we apply to that term, were first established. They were three 
in number, theology, law, and medicine; the professors, as well as the 
whole body of teachers attached to the university remaining ecclesias- 
tical; and the pupils being like those of all other branches, clerical. 
Before this period the only division that had been made of the mass of 
pupils attending to the various branches taught in the schools of art, was 
into nations — a division which still continued even after the for- 
mation of the faculties. These nations consisted of individuals of 
the same or neighbouring countries, including occasionally a few 
from more distant districts, who, whatever might be the nature of 
the studies for which they had resorted to Paris, united together into 
a body, and lived in separate buildings erected for that purpose and 
denominated colleges. Each of these nations framed its own laws 
and regulations, was governed by officers of its own choice, and did not 
necessarily keep up a communication with the other nations, except 



112 Medical School of Paris. 

when they assembled together to constitute the great council of the uni- 
versity, and to transact business of a common interest. At an early 
period of their formation, (the exact period is not known, some wri- 
ters referring it the reign of Charlemagne, others to those of Louis 
the seventh and of Philip Augustus,) the number of these nations was 
very limited, consisting, as is affirmed by some, of only two, the 
French and the English. In the course of a few years they increased 
in number, so that at the close of the thirteenth century they amount- 
ed to four, those of France, Picardy, Normandy, and England. 
They ranked in the above order. The first, besides the French, in- 
cluded Italians, Spaniards, Greeks, and Orientals; the last the 
Scotch, Irish, Poles, Germans, and all other northern students. 
Each nation was divided into provinces, and each of these into dioces. 
The provinces had each at their head a dean. These formed the or- 
dinary council of the procurator or head of each nation. The pro- 
curators, in their turn, constituted the ordinary council of the rector, 
who was chief officer of the university. Besides the ordinary 
council just alluded to, there was a great council, consisting of the 
rector, procurators, and deans. Of the causes which led to the 
change in the division of the pupils, and to the formation of the fa- 
culties, we need not here occupy the attention of our readers, and 
must refer them, for all that can be desirable to know on that head, 
to Dr. David Johnston's work on education in France. It will be 
sufficient to remark that the faculty of theology was the first formed, 
and that that of medicine was soon after modelled upon the former, 
since it is proved that so early as 1270 one of its members was pu- 
nished for contravening one of the statutes. Shortly after this, the 
faculty of law, (canon,) was similarly organized. About the year 
1281, the three faculties of theology, medicine, and canon law were 
confirmed in all their rights and privileges, and thus assumed equal 
rank with the four nations already mentioned, which had not ceased 
to exist, and now received the name of faculty of arts.* 

* There was at that time a curious custom, which was continued for a long time ; 
it consisted in giving to each nation and faculty an honorary title. This was not 
merely made use of in common parlance, but was retained in all acts and sta- 
tutes. What these titles were may be seen by the annexed list of deans and 
procurators of the different faculties and nations. 

J. Mullot, Decan. Sacrae facultatis Theologix; Ph. De Buisine, Decan. Con- 
mltissimx, facul. jur. Canon; Guido Patin, Decan. Saluberrimse, fac. med,; J. 
Doge, Honorandse nationis Gallicx, Procurator; G. De Lestoc, Fidellisimx nat. 
Picard. Procurator; Th. Le Petit, Venerandae, nat. Nor. Procurator; Mac Na- 
mara, ConstantissimaSf nat. German Procurator. 



Medical School of Paris, 113 

The medical faculty of the university, which constitutes the prin- 
cipal object of this article, attained considerable reputation, even 
soon after its definite organization, and was regarded, for a long time 
as the best in Europe, with the exception of that of Montpellier. 
Students flocked to Paris to attend the lectures of the professors, and 
we have already seen the effect produced by them on the young lite- 
rati of the times, who were no where to be found except among the 
inmates of cloisters and monasteries. The founders of this school were 
under the impression, that in order to establish a faculty capable of im- 
parting solid instruction, and calculated to do honour to the great metro- 
polis in which the school was located, it was necessary to have recourse 
to two measures. 1st. To insist on the necessity of following nature 
agreeably to the views expressed in the writings of Hippocrates and 
Galen, and 2dly, to profit by the labours of the two more ancient 
schools of Cordova and Salerno. To accomplish these objects they 
had recourse to the various translations then in circulation, of the 
writings of the two fathers of medicine — the original texts having been 
carried away from the continent to Arabia by St. Benedictus and 
others — as well as to the writings and commentaries of the professors 
of the celebrated schools we have just mentioned. It was not until 
about the middle of the fifteenth century, however, that these efforts 
to raise the reputation, and establish the preeminence of the school 
of Paris, were crowned with full success. In their laudable zeal 
to that effect, the professors were much aided by the discovery of 
printing, which took place about this period, and by the protection 
which the school of Paris, as well as every other in the kingdom, 
received from King Francis the first, who, by his munificence, in- 
duced savans from all parts of the world to collect in the capital of 
his kingdom. From this period to the beginning of the seventeenth 
century, the progress of the school was rapid. During that period 
translations from the origiginal texts were made, and commentaries 
on these, as well as original works, written in accordance with the 
principles of_the Hippocratic school, were published. As early as 
1532, Joannes Campegius, in an epistle cited by his uncle Sym- 
phorianus Campegius, physician to Charles the eighth and Louis 
the twelfth, speaks in terms of high praise of the learning of Parisian 
physicians in the Greek language and in medical science. Riolan, 
from whom we derive this information, states, that in 1551, Casa- 
tus, a learned Scotch physician, expressed a similarly favourable 
sentiment respecting the school of Paris. Lorry, in his preface to 
Astruc's history of the school of Montpellier, says of the be- 
ginning of the seventeenth century, "this era is that of the true 

No. XV.— May, 1831. 11 



114 Medical School of Paris. 

glory and lustre of the faculty of medicine of Paris; no body of phy- 
sicians has produced such skilful interpreters, such illustrious com- 
mentators of our first masters as this faculty. The spirit of obser- 
vation, according to the Hippocratic method, drew forth from its 
members works still precious at the present time." Were other 
testimony of the high and merited renown of the school of Paris 
necessary, it might be sought for in the first book of Baglivi's 
work on the practice. It will be sufficient in order to show, that the 
praise contained in these quotations is not exaggerated, to remind 
the reader, that it was at the period in question, that Bouvard, 
Degorrhis, Bressot, Vasse, Fernel, Cop, Gonthier, D'Ander- 
nack, Hollier, Goupil, D'Allemand, the two Durets, Ballou, 
Akakia, &c. all names of the highest renown in the annals of our 
profession, flourished at Paris, and took an active part in promoting 
the progress of medical knowledge, and raising the reputation of the 
school to which most, if not all, of them were attached. 

As regards the period at which the faculty of Paris began to cul- 
tivate with the greatest success the various branches of medical sci- 
ence, and the progress these made in that city, it would be a waste 
of time to say much in this place. A few words on the subject, how- 
ever, may not be misplaced here, inasmuch as we shall thus be able 
to present a view of the state of the school previous to the French 
revolution, as well as to notice the origin and progress of the college 
or school of surgery, which grew out of that of medicine. 

The. first lessons given in anatomy were for the instruction of the 
barbers and surgeons. To the former they were delivered in French,- 
to the latter in Latin. This occurred in the years 1498 and 1499, 
(Pasquier, Rech. surla France, Liv. 9, Chap. 31.) Weneedhardlv 
state that previous to, and even at the period we have mentioned, 
this branch was in a state of infancy, and that these first attempts to- 
wards the delivery of a course of instruction in it must have met 
with but a slender success. This does not in the least detract, how- 
ever, from the praise to which the school of Paris is entitled on that 
head, since the lectures delivered on the same subject in other uni- 
versities of Europe, do not appear to have been superior, or even as 
good as those of the former. In the course of a few years, works 
were published on this branch, disputations were carried on, and 
many discoveries made. Nevertheless it was not until the commence- 
ment of the sixteenth century that anatomy was properly taught The 
names of Charles Etienne, Gonthier the master of Vesalius, 
Riolan, Fagault, Gourmelin, and particularly of Sylvius, who, 
although a graduate of Montpellier, may, in consequence of his long 



Medical School of Paris. 115 

residence in Paris, be classed among the former — most of whom 
flourished in this or the commencement of the succeeding century, 
will, owing to the zeal they displayed in their dissections, and to 
the degree of perfection to which they carried this important branch, 
ever live in the memory of anatomists, and reflect the highest 
honour on the city and faculty of Paris, To these anatomists suc- 
cessively followed LlTTRE, DUVERNEY, WlNSLOW, HuNAN, PETIT, 

Lieutaud, and Yicq D'Azyr, who carried the science to still greater 
perfection than had been done by their predecessors. 

Anatomy having much improved, the functions of the different 
parts of the body were explained in a less conjectural and specu- 
lative manner than had hitherto been done. Yet physiology cannot 
be said to have considerably improved at Paris previous to the mid- 
dle of the seventeenth century, when, the circulation of the blood 
having been discovered, and physical and mechanical science 
having made great progress, the former assumed a better direction, 
and new, though not always correct explanations of the phenomena 
of life were offered. The books containing these physiological specu- 
lations, although no longer read but by the erudite, may be regarded 
as productions of great interest. In the progress of time, however, 
physiology emerged from the obscurity in which the Gallenical doctrine 
had long held it enchained, and a Bordeu, a Fabre, a De Caze, a 
Vicq D'Azyr, and others, gave to the physiological school of Paris 
an impulse which has led to the most beneficial results, and ensured to 
it a reputation equal to, if not greater than that enjoyed by any other. 

Nor was the success of the members of the Parisian school less con- 
spicuous in surgery. In the origin, both medicine and surgery were 
taught under the name of physic. When universities were established, 
the same name for both was retained in Italy, while the term medecine 
was conferred upon them in France. In the twelfth century the church 
prohibited its members from performing operations, on the plea that 
a priest should entertain a horror for blood. Hence the physicians 
who wished to continue the practice of the art, were compelled to 
leave the faculty. In this century and the succeeding one, surgery 
was left almost entirely in the hands of the barbers. A floating banner 
over three pewter basins, formed the significant sign of the barber- 
surgeons. Even women performed surgical operations, provided they 
could obtain permission to that effect from the king's surgeon at the 
Chatelet. The surgeon-barbers were not members of the university, 
which would not even grant them the title of pupils. In truth, they 
were very ignorant, all their art consisting in setting broken bones, in 
bleeding, in cupping, and in shaving. In addition to this, they some- 



116 Medical School of Paris. 

times kept warm baths, for the accommodation of invalids and the 
public generally. They were often at open warfare with the regular 
physicians, who reproached them with selling medicines and recipes 
not approved of by the faculty. 

As early as 1272, several surgeons, headed by Pitard, had, as we 
have already hinted, separated from the faculty, in order to institute 
a college, which though distinct from, yet remained under the juris- 
diction of the faculty. The members of this college being considered 
as lay members, (those of the university were still regarded as cleri- 
cal,) had permission to marry, enjoyed all the privileges possessed 
by the masters in surgery, and wore the same costume. Soon after, 
Lanfranc joined this college and became one of its most distinguish- 
ed members. The college was placed under the patronage of the St. 
Come and St. Damiens. From their costume the members were de- 
nominated surgeons of the long robe, in order to distinguish them 
from another set of surgeons, who were called chirurgiens de robe 
courte, and were formed into a community under the direction of the 
head barber of the king, J. Pracontal. They were obliged to study 
medicine for two years, and to submit to strict examinations. Ac- 
cording to Pasquier, (Rech. de la France, ch. SO, p. 817,) the con- 
federation of surgeons was only instituted by an edict of Philip the 
Fair, in 1311, but there are not wanting some writers who prefer to 
this opinion, that of the author of the Index Funerius Chirurg, Pari- 
siensium, who refers this establishment to St. Louis. Be this how- 
ever as it may, the college of surgeons, from the order given by Phi- 
lip, which enjoined on all the surgeons of France to present them- 
selves for examination before it, and assimilated its members to those 
of the faculty, as well as in consequence of the practical success of 
its members, and the suffrages it obtained from the academy, had to 
sustain a war with the faculty. In this dispute the latter obtained 
some advantages over the college, and exacted a sworn promise from 
the bachelors, before giving them a license, that they would never 
practice surgery; yet the members of the college became more elevat- 
ed in repute and standing than the barbers and stuvists, who, by an 
act of parliament dated 1425, were prohibited from performing ope- 
rations. The faculty, however, who had obtained an edict from King 
JohntheGood, in 1352, prohibitingall who had not procured a license, 
such as apothecaries, students, and mendicant friars, from practising 
the healing art, took the defence of the barbers, from a spirit of re- 
venge against the college, and taught them the practice of surgery. 
Complaints were made in 1491 and 2, but to little effect; for the fa- 
culty continued, as heretofore, to deliver lectures on anatomy for the 
benefit of the barbers. The surgeons on their part reiterated their 



Medical School of Paris. 117 

complaints, and obtained that the public dissections should be en- 
trusted to them, and that each among them who would pay an an- 
nual sum of thirteen sous to the faculty, should be entitled to a pre- 
eminence over the barbers. But all their complaints were left un- 
noticed, and in 1505, the faculty still nourishing their inveterate 
hatred of the surgeons, declared the barbers children of the faculty. 
They were enregistered as such, engaged themselves on oath not to 
make use of internal remedies without calling in a member of the 
faculty, and submitted to examinations before obtaining the degrees 
of master. They were now no longer designated by the term Barbi- 
tonsores, but by the less dishonourable one, given them by the facul- 
ty, of Chirurgici a tonstrina, or of tonsores chirurgici. 

In 1515, the college, while under the presidency of E. Barat, 
applied directly to the university, and obtained the abrogation of 
most of the privileges possessed over its members by the faculty of 
medicine, and an edict of the university immediately followed, by 
which the surgeons of Paris were declared members of the faculty. 
About the same time, William Vavasseur, first surgeon to Francis 
I. obtained the separation of the corporation of surgeons from that of 
the barbers, and also a decree by which every master in surgery was 
enjoined to present certificates of his knowledge in Latin and of his 
skill in the science of dialectics before lie could obtain a license to 
practice. By these measures the college of surgery was raised to an 
equal rank with the learned schools. It finally obtained permission to 
confer degrees of master, bachelor, licenciate, and doctor in surgery, 
and obtained from Henry II. prerogatives equal to those enjoyed 
by the faculty. In 1557" the decree of 1515 was, however, annulled 
through the efforts of J. Buhamel, dean of the faculty, and the sur- 
geons were once more forced to submit to the examinations of the latter. 
In 1577 the college again obtained a confirmation of their privileges 
and of the right of conferring academical honours. Two years af- 
ter, the faculty endeavoured to divest the college of the independence 
thus granted to it; but failed, in consequence of the former receiving 
from Pope Gregory XIII. an indullo similar to that sent to the univer- 
sity. The college now prospered so rapidly, that in 1506 it felt pow- 
erful enough to compel the barbers to call in a regular surgeon for 
advice in all severe cases. All these privileges were confirmed in 
1602 by Henry IV. and in 1614 by Louis XIII. 

The eighteenth century is really remarkable for the number of 
brilliant discoveries and improvements that were made in surgery. 
The number of men of genius and talent who flourished in France 
during that period is almost inconceivable, and it is no small praise 

11* 



118 Medical School of Paris. 

to say, that it was at this time the weight of authority in matters 
of science gave way to that of reason and experience. 

In the latter half of the century to which we here refer, two indi- 
viduals equally distinguished by their talents and the rank they oc- 
cupied in the profession, Bienaise and Roberdeau conceived the 
praiseworthy design of promoting the cause of the surgical science. 
They established and maintained, at their own expense, in the schools 
of surgery, which, from a variety of causes were in great measure 
deserted, several chairs for the demonstrations of various branches. 
While this amelioration was effected in the regular surgical schools, 
Louis XIV. reorganized, by a declaration dated December, 1671, the 
royal school of surgery of the garden of plants, of which we shall 
speak by and by, and very wisely ordered that henceforward the 
teaching of that branch, which had been claimed as a privilege by the 
doctors of the faculties of Paris and Montpellier, should be entrusted 
to a surgeon. Dionis was appointed to the chair of anatomy and 
operative surgery,* and gave eclat by his skill and reputation to the 
establishment. 

At the solicitation of Mareschal and Lapeyronie, the king, by 
letters patent of the month of September, 1724, ordered the estab- 
lishment in the college of St. Come of five chairs, the incumbents 
of which were charged with teaching all the branches of anatomy 
and surgery. To these chairs Lapeyronie added a sixth, which he 
himelf endowed, and the professor of which was called upon to de- 
liver two courses on midwifery; one for surgeons, and the other for 
midwives. At his instigation also a number of adjuncts equal to 
that of the demonstrators were appointed, the expenses of whom he 
offered, in the most liberal manner, to defray himself. The faculty 
did not limit itself at this time to protesting against the independence 
of the college, but even attempted to overcome it by force. We find in 
Quesnay a ludicrous account of the assault which was made by the 
doctors of the faculty, aided by their pupils, and headed by the 
dean; the doctors being all dressed in their robes and caps, the dean 
decorated with all the insignia of his high office, and a professor 
carrying a skeleton ! When they reached the door of the anatomical 
room of the college, an officer or beadle struck with force against it, 
and cried out "void vos seigneurs et maitres de la faculte qui 
viennent reclamer le droit de vous instruire: — here are your lords and 
masters of the faculty who are come to claim the right of instructing 
you." They are come, adds the witty author, to seize upon the 

* Dezeimeris, Journal Hebdomadaire, Vol. 8, p. 307. 



Medical School of Paris, 1 1 g 

amphitheatre which you could build only for them, they carry to you 
all the knowledge contained in their books. But from this attack 
no other results were obtained, than exciting the laughter and hisses 
of the populace, who serenaded in this manner the infuriated pro- 
fessors all the way back to their homes. 

In 1743, (23d of April,) the king, by a declaration drawn up by 
Daguessau, and which is in every way worthy of that celebrated 
man, ordered that the society of surgeons should be finally cleared 
of the community of barbers, by an alliance with which it had been 
so long disgraced. Academical degrees were instituted among the 
surgeons, the pupils were required, before being allowed to graduate, 
to present testimonials of having received a liberal education, and to 
undergo several strict examinations in the different parts of that 
branch. Shortly after, by an arreteof the council dated the 4th of July, 
1750, the Eeole Pratique de Chirurgie was established. This school, 
which was intended, as its name imports, for the instruction of pupils 
at the bed-side of the sick, was remodelled in March, 1760, and af- 
terwards established in a small and special hospital, known under 
the name of Hospice de Perfectionement, and which was founded by 
an edict of the king, dated December, 1776. It was in this school 
that Desault commenced his career as a clinical professor, and 
that Chopart taught with such distinguished success. 

But to return from this long digression to which we have been led 
by the circumstance, that the college of surgery at Paris, formed ul- 
timately a distinct school, independent of the university, and as 
such merited more than a passing notice. Following at an early pe- 
riod the example set them at Montpellier, by Guy de Chauliac, 
who had already published a treatise on surgery, Lanfranc, (a na- 
tive of Milan, but long settled in Paris,) Ambrose Pare, Ma- 
rescot, Charpentier, Fagault, Gourmelin, not to speak of other 
individuals of less celebrity, published many valuable works, — the 
two last, treatises on this branch. After these came Lapeyronie, 
J. L. Petit, Morand, Ledran, Garengeot, La Faye, Verdier, 
Pibrac, Hevin, Fabre, Le Cat, Fouhert, Bordenave, Sabatier, 
Puzos, Housted, and Louis, all of whom were members of that ce- 
lebrated academy of surgery, of which Paris has so much cause to 
be proud, and which was formed about this time. 

Paris may also be cited for the success with which midwifery and its 
accessory branches were cultivated by some of the disciples of the 
school, and other individuals not connected with the latter, but re- 
siding and practising in that city. At first abandoned there, as in 
every other part of the world to ignorant hands, this branch began 



120 Medical School of Paris. 

about the sixteenth century, to be cultivated by well-informed 
surgeons. Without stopping to enumerate several early essays on 
this subject, published by authors long since forgotten, it will be suf- 
ficient for our present purpose to mention as deserving a high commen- 
dation — viewing the period at which they were written — a treatise by 
Guillemeau, " Be la grossesse et Accouchement desfemmes, du Gou- 
vernement dHcelles, et moyens de subvenir aux accidents qui leur ar- 
rivenU" &s well as a dissertation on impotency added to that work, 
by Charles Guillemeau, the son of the preceding author, and who 
for a time was dean of the medical faculty. At a subsequent period, 
the writings of Mauriceau, Puzos, Viardel, De Lamotte, Lev- 
ret, and particularly of Petit and Baudelocque, attest sufficiently 
the early period at which midwifery began to be properly cultivated 
at Paris, and the improvements made in the philosophy of that 
branch, previous to the revolution, by the faculty and practitioners 
of that city. Let it not be forgotten, moreover, that about the mid- 
dle of the seventeenth century the instruction of midwives was be- 
gun, at their own request, and became the source of an establishment 
which has proved of the highest utility to the city and provinces. 

Pathological anatomy was later in being studied with success at 
Paris than the preceding branches; for, with the exception of Bail- 
lou, Ambrose Pare, Fernel and Pineau, and notwithstanding the 
example set them by Eustachius and Morgagni in Italy, Bonetus 
in Switzerland, Dodoneus, Donatus and Kentman in Germany, no 
writer had there published any thing of much value on that important 
subject, until the time of Littre, Duverney, Dionis, and L. Pe- 
tit. Soon after, however, Lieutaud, VicqD'Azyr, and some others, 
published works of considerable interest on that branch, and were the 
honourable predecessors of Portal, Bichat, Bayle, Laennec, &c. 

Belon, a physician of Paris, actuated by an unusual degree of 
zeal in the prosecution of botanical knowledge, undertook long and 
perilous voyages, with a view of enriching this department of science. 
He was protected by Fernel, who at that period enjoyed a great and 
merited favour, and was aided by the liberalities of Henry III. In- 
dependently of Belon; Barrelier, Fagon, Tournefort, Jussieu, 
Vaillant, and other distinguished naturalists of Paris, procured in 
the four quarters of the world, innumerable specimens of natural 
history, and enriched the catalogue of the materia medica by the ad- 
dition of many articles of more or less value. The establishment of 
the royal garden of plants by La Brosse and Fagon, which was effect- 
ed in the reigns of Louis XIII. and XIV., contributed in promoting 
the progress of botanical knowledge and of the materia medica; since 



Medical School of Paris. 121 

by its means all the treasures of the known world were collected 
in a small space; while learned professors, appointed with the ap- 
proval and at the recommendation of the faculty of medicine, studied 
and explained to a numerous class, the uses and properties of the 
various objects which that garden contained. 

Astrology early met with a decided opposition on the part of the 
faculty of medicine of Paris. The " Lispensatorium Galinico-Chy- 
micum," of Renodeus, a work more commendable for the erudition 
it displays, than for the judgment and taste with which it was com- 
posed, is sufficient to indicate that at an early period pharmacy and 
materia medica had attracted the attention of Parisian physicians. 

Ipecacuanha was, as is well known, introduced in Paris as a thera- 
peutical agent, by a pupil of the school of that city, Helvetius, and it 
was extended thence in 1686, to every part of Europe. Peruvian bark 
was used in the case of Louis XII. and soon after employed with success 
by many physicians and professors of Paris. The works of J. A. Hel- 
vetius, the son of the preceding physician of that name, and of 
Monginot, show the success with which this medicine was there 
employed and compounded. As regards mineral articles, it is known 
that the physicians of the Parisian school employed them with as much 
success as those of any other, and prepared them as well as the 
state of pharmaceutic chemistry would allow. The different prepara- 
tions of antimony and mercury, met at their hands a cordial recep- 
tion. The reverse of this is not to be argued from the fact, that the 
faculty of the University procured in the year 1566, a decree of par- 
liament against the former of these articles — that Bernier, one of 
its members, was expelled from this school in 1609, for continuing to 
resort to it in his practice, and that a few years anterior to this, the 
celebrated Theodore Turqjjet of Mayerne, was persecuted for a si- 
milar offence. For such a prohibition was founded on the abuse made of 
this remedy, and on the improper manner in which it was prepared and 
administered; and it is well known that many physicians of emi- 
nence continued to use it, and to take openly and fearlessly its de- 
fence. Be this as it may, at a later epoch many treatises on the ma- 
teria medica were published, the most esteemed of which about the 
opening of the revolution, were those of Lieutaud, and Des Bois 
De Rochefort. 

In pathology and the treatment of disease, much had been written, 
but little of decided advantage had been effected by the professors 
of the medical school, and by the physicians of Paris, up to the mo- 
ment of the reorganization of the faculty and school; yet the writings 
an those subjects of Lieutaud, Bosquillon, Quesnay, Des Bois de 



122 Medical School of Paris. 

Rochefort, Raulin, Portal, Lorry, &c. not to mention those of the 
older physicians we have already noticed, must, considering the 
state of science at the period at which they were composed, be re- 
garded as productions of uncommon merit. 

Clinical medicine was not taught at Paris until a short period prior 
to the revolution; the merit of first setting the example in France of 
delivering regular lectures on this branch, being indubitably due to 
Des Bois de Rochefort, chief physician of the hospital of La Charite, 
where he was succeeded in 1788, by the celebrated Corvisart. 
It is proper to remark, however, that although, as we have just 
stated, the necessity of teaching medicine at the bed-side of the 
sick, was not felt in France until the time of Des Bois de Roche- 
fort, the surgeons who flourished in the preceding age, although unau- 
thorized, or rather uncommissioned to that effect, had been in the 
habit of bringing along with them at their visits, or to their operations 
in the hospital, their private pupils, their friends, and strangers, 
whom the anatomical lectures of Duverney, Littre, Mery, and 
Winslow, attracted at Paris. Such was particularly the case with 
Saviard at the Hotel Dieu; with Mareschal and the lithotomist 
Tolet at the Charite, and with Mauriceau in the lying-in wards 
of the former of these hospitals.* 

Whilst such were the advances made in the different branches of 
medical science by the members of the faculty and the physicians of 
Paris, chemistry remained in arrears, not so much in consequence of 
the indifference in which it was held by the faculty, as owing to the 
state of knowledge at the time, and to the prejudices existing against 
this branch. At the beginning of the seventeenth century, knowledge 
had advanced sufficiently to open the eyes of the public respecting 
the fallacy and absurdity of judiciary astrology and magic, a belief in 
which prevailed to a considerable extent in the preceding century; 
hence we find that the faculty of medicine opposed them with vi- 
gour. But there yet remained much to accomplish, for the purpose of 
enlightening the minds of the multitude to such a degree as to enable 
all to perceive the exact relation existing between different branches 
of inquiry. This was well exemplified by the single fact, that for a 
long time it was found impossible to persuade the generality of the 
people that there existed a vast difference between magic and che- 
mistry, owing to the circumstance that by the latter, results that ap- 
peared to many extraordinary and even supernatural, were obtained. 
From this strange prejudice arose the prohibition made by all the tri- 

e Bezeimeris, 






Medica I School of Paris, 123 

bunals of Paris, of selecting chemical subjects as the theme of the 
dissertations of the graduates, and of delivering lectures, either 
public or private, on this science. This dislike to chemistry was much 
seconded by the esteem in which the Aristotelian philosophy continu- 
ed to be held, as well as by the prejudices then prevailing against the 
principles of Descartes. Add to this, that the alchymistshad greatly 
contributed to alienate the minds of many, perhaps involuntarily, 
against chemistry, by the obscurity in which they had affected to veil 
their art, and by the interested motives which almost invariably 
guided them in their public and private conduct. 

With the progress of knowledge, however, such prejudices gradu- 
ally disappeared, the prohibition against prosecuting the study and 
teaching of chemistry was withdrawn, and the faculty undertook its 
defence with zeal, neglecting no opportunity calculated to extend a 
knowledge of its principles and of its applications. It is strange that 
even at this period, the most violent opponents of chemistry , 
should have enumerated among their partisans, men of learning 
and talent, such as Guercetan, Angelus, Sala Delannay, 
and P Paulmier. Such were the men the faculty thought it 
necessary to combat, being, as they were, more capable of producing 
an impression on the public mind, and of giving an unfavourable opi- 
nion of chemistry. The opposition of the faculty had not been di- 
rected to chemistry, and particularly to medical chemistry, but to 
the fatal application that was made of it during the whole of the six- 
teenth century, and a considerable portion of the seventeenth, by the 
alchymists, who imagining that every thing took place in the human 
body, exactly as they found them to occur in their crucibles, ex- 
perimented accordingly, very much to the detriment of their patients. 
The medical faculty of Montpellier, situated as it was nearer than 
that of Paris to the Arabs of Spain, applied itself early to the study 
of medical chemistry, and contributed greatly to the diffusion, all 
over the kingdom, of a knowledge in this science. In that city there 
arose several chemists of great distinction, of whom we shall only 
mention Venel and the two Des Maltes, because in their laborato- 
ries was trained Lemery, who had before commenced the study of 
chemistry under Glazer, at the garden of plants of Paris, and who 
having subsequently returned thither, taught that science with such 
success, that forty Scotchmen are said to have come all the way from 
their country to attend his lectures. Lemery published a work on 
antimony and an elementary treatise on chemistry, a universal phar- 
macopoeia, and a dictionary of simple drugs, from which it will be 
easy to form an idea of the extent to which he contributed in clearing 



124 Medical School of Paris. 

chemistry of the obscurity in which it had heretofore remained enve- 
loped. Louis Lemery, the son of the preceding, studied chemistry 
under his father, became a member of the faculty, and was regarded 
at one time as one of the greatest chemists of the age. Towards the 
middle of the seventeenth century, chemistry began to form a part 
of the course of instruction afforded in the amphitheatre of the garden 
of plants by professors designated for that purpose by the faculty, 
and appointed by the king. In the performance of this honourable 
duty, St. Yon, Geoffroy, Lemery, Bourdelin, and Macquer 
succeeded to each other. These names indicate in a convincing man- 
ner the progress which chemistry had made in Paris. About the same 
time the faculty recommended strongly the study of this science and 
established annual courses of pharmacy, which were continued for a 
long time, and were numerously attended.* We need not continue 
this historical sketch of the progress of chemistry at Paris down to 
the period of the revolution, as the names and labours of Lavoisier, 
Guyton Morveau, Berthollet, Fourcroy, Chaptal, &c. are suf- 
ficiently known and appreciated. 

From the preceding account of the old medical school of Paris and 
the brief recapitulation we have offered of the individuals among 
its professors or alumni, who rendered themselves conspicuous 
in the various departments of the medical science, we are led to 
the conclusion, that the present school of that city need not be asham- 
ed of its parent. Perhaps, indeed if we take into consideration the 
state of science, and compare the men who nourished at both pe- 
riods, we might be tempted to think that the old school would, if it 
came once more upon the stage of the world, entertain a very differ- 
ent feeling towards her offspring, such at least as it was but a short 
time ago. But we must not anticipate here what we have to say on the 
subject of the present school. In the next number we shall com- 
plete our historical notice of this establishment, and offer a brief 
sketch of the plan of instruction adopted in it at the present time. 

* See Hazon, Notice des hommes les plus celebres de la faculty de medecine 
de Paris, p. 92, &c. 



( 125 ) 



REVIEWS. 

Art. XII. A Treatise of Pathology and Therapeutics. By John 
Esten Cooke, M. D. Professor of the Theory and Practice of 
Medicine in Transylvania University. In three volumes; Vols. I 
and II. (Volume III. unpublished.) 8vo. Lexington, 1828. 

AN extended treatise on pathology and therapeutics from the west 
of the Alleghany, is no ordinary occurrence, even in this book-making 
age, and we greet its appearance with kindly feelings and national 
pride. Kindred with that people, not less by consanguinity than by 
government and language, their rapid advancement is to us a subject 
both of exultation and astonishment. Their vast country, but yes- 
terday a boundless wild, where the rude savage roamed, is now a 
cultivated domain, inhabited by a powerful people, possessing all the 
arts and elegancies of civilized life, and prepared to enter the field 
of scientific research, in honourable strife with her elder sister and 
the old world. May their career be as brilliant as their rise has been 
unexampled and auspicious, and no other feelings than those of com- 
mon country, be permitted to mingle in our mutual intercourse. But 
let us not carry our home partialities too far. Science is of no coun- 
try, and from whatever quarter it issues must be judged of on its own 
merits, apart from national feelings or foreign prejudices. This 
standard we shall endeavour to apply to the examination of the work 
before us, not regardless of that comity and respect which is due to 
the learning and distinguished station of its author, however his novel 
doctrines may be little accordant with our own experience and 
opinions. 

The treatise opens with some judicious observations on the proper 
method of pursuing medical investigations, in order to arrive at just 
and permanent principles; and the author next expatiates on the 
causes which have retarded the progress of the science. The great 
cause of this evil he attributes to the extreme proneness of physicians 
to frame hypothetical theories from partial and limited premises, in- 
stead of tracing up the varied phenomena of disease through their 
chain of causes to the first or remote cause of the derangement, in the 
true spirit of the inductive philosophy. After such an explicit avowal 
of views which we have been taught to consider as the only sound 
procedure for the attainment of a correct system of pathology, aided, 
No. XV.— May, 1831. 12 



126 Cooke's Pathology and Therapeutics. 

however, by a knowledge of the laws of physiology and autopsic in- 
spection, we did not expect to find the author straightway propound- 
ing a theory of his own, which, we fear, will be found to. rest on no 
better data than he had the page before deprecated. This theory is 
no further novel than in the extensive application made of it to ex- 
plain the production of the multiform characters of disease, but as it 
constitutes the key-stone of the system of pathology, which this 
treatise is devoted to verify and enforce, we shall give it in thje 
author's own words, that the reader may be fairly put in possession 
of the aim and tendencies of the work under consideration. 

" The first question which pressed on his mind, related to the cause of the 
derangement of the functions of the liver in the autumnal diseases. The symp- 
toms observed were very commonly, by the mass of people and by many phy- 
sicians, attributed to superabundance of bile, and this as well as many other 
popular notions, was derived from high authority informer days. The obvious 
relief afforded by a free discharge of bile, gave considerable countenance to the 
opinion; but the unanswerable objection was, that very often there is no bile 
discharged either from the stomach or the bowels, by the most active medi- 
cines, and the symptoms are more severe than in those cases in which there is 
an abundance of that fluid— and that a free secretion of bile is a most desirable 
object. It was evident then that the morbid symptoms are produced not by 
bile, but by the retained material of which bile is formed, viz. the blood in the 
liver. This led to the doctrine of congestion in that viscus being the cause of 
the disorder observed, a doctrine advanced by many late writers. 

"It was very evident that this cause is capable of producing an increased se- 
cretion of bile, but the question arose, can it likewise produce a suppression of 
the secretion? From what occurs in the mamma after parturition, there is rea- 
son to believe it can. In that gland, a certain degree of congestion or accumu- 
lation of blood, produces increased secretion; a higher degree, such as pro- 
duces hardness, suppresses secretion entirely. 

*' The next question was, how are the other parts, the stomach, the head, 
&c. affected? By sympathy, is the common answer; which, while it acknow- 
ledges an intimate connexion between these parts, conveys no precise idea of 
it, and contains no explanation of its nature. 

" Revolving in his mind the nature of this connexion, the thought struck him 
that congestion, or accumulation of blood cannot exist in the liver, without ex- 
tending into the vena cava, and its great branches, the jugulars, the emulgent 
veins, and the internal and external iliac veins; nor without producing an accu- 
mulation in all the veins leading into the liver, viz. in the veins of all the chy- 
lopoietic viscera. It was at once apparent that the same accumulation must af- 
fect the brain, and the stomach and bowels; and derange the functions of the 
latter, at the same time that it deranges those of the liver. Further reflection 
led to the observation, that the same accumulation affects the kidneys and the 
uterus also. 

" Considerable time was spent in tracing out the effects of this accumulation 
of blood in the vena cava and its branches, iii the several parts in which they 
are situated. 



Cooke's Pathology and Therapeutics, 127 

" It was found that this cause is capable of producing- pain in the head, verti- 
go, stupor, &c; enlargement of the liver and pain in that part, increased se- 
cretion of bile, with nausea, vomiting- and purging- 5 or suppressed secretion and 
constipation; and in the glands of the stomach, increased secretion with raven- 
ous appetite, or suppressed secretion and consequent want of appetite, flatu- 
lence and acidity; together with derangement of other parts not necessary to 
particularize. 

" An accumulation of blood in the interior veins was thus found to be capa- 
ble of producing the symptoms preceding and accompanying fever: it still re- 
mained to account for the increased action of the heart and arteries. Blood 
being the natural stimulus of the heart, it is evident that a sudden increase of 
the quantity poured into it, must produce increased action of that organ, if it 
be at the time capable of it. The sudden accumulation therefore which takes 
place in the cold stage of fever produces the increased action that follows; 
while the above-mentioned affections of the head, stomach, liver, &c. which 
precede fever, are the effects of gradual accumulation of that fluid in the vena 
cava, &c. 

"The next question was, what is the cause of this accumulation? It had been 
observed that weakened action of the heart is always present in the commence- 
ment of these autumnal diseases, and that it is produced by all the remote 
causes of fever; and it was evident that it must, whenever present, necessarily 
produce accumulation of blood in the vena cava, &c. ; and therefore that this 
is the cause." 

The facts and arguments on which this theory rest for support, will 
be examined as they occur in course. For the present, we shall con- 
tent ourselves with remarking, that it is much too mechanical for ge- 
neral reception in this age of physiological and vital pathology; and, 
moreover that it is no where shown that the liver is actually in a state 
of congestion, or that the vena cava and its branches seriously suffer 
from an accumulation of blood in the precursory stage of fevers, 
though it must be admitted that such accumulation to a certain ex- 
tent constantly takes place during the continuance of rigors, from 
whatever cause induced; consequently, we are constrained to class 
this theory, according to the author's own definition, among those 
hypotheses which have been so long the bane of medicine. 

After passing in review some of the more prominent doctrines, 
from Hippocrates to the time of Rush, which have exercised a con- 
trolling influence over the science, and pointed out what he conceives 
to be their radical defects, especially their neglect to trace the symp- 
toms of disease through their train of causes up to their remote cause, 
he proceeds to the consideration of the several remote causes of 
fever. These he endeavours to prove are all either directly or in- 
directly debilitating. On this point we would remark, that whatever 
may be the mode of operation of these causes, it cannot be denied 
that fever does not take place until a general or local irritation is set 



128 Cooke's Pathology and Therapeutics, 

up, which is, indeed, itself a state of fever, whenever the irritation 
is sufficiently intense to affect the rest of the system. Besides, the 
view taken of the operation of the remote causes, necessarily supposes 
fevers to be idiopathic and general affections, a doctrine fast vanish- 
ing from the minds of physicians, and which the researches of 
Broussais, Louis, Andral, and others, particularly the pathological 
anatomists, render more than problematical. We cannot at this 
time enter upon the discussion of this interesting and important 
question, for it would lead us too far away from the subject in hand, 
and must therefore refer the reader, for a triumphant refutation of the 
ancient errors on this subject, to Broussais's Examination and the 
Pyretology of Boisseau, of which latter work a full analysis was 
given in the last number of this Journal. We will merely observe 
in passing, that if it can be shown, as we believe it can be, that the 
fevers heretofore esteemed idiopathic arise from local irritations, and 
are nearly allied with phlegmasial affections, that then whatever 
may be the nature of the remote causes inducing them, that these 
causes must be either directly or indirectly essentially stimulating in 
their operation, a conclusion in contravention of the author's theory. 
Let us, however, examine a little in detail his explanation of the mode 
of action of some of the more frequent of these causes, in order' that 
we may be enabled to judge how far he has been successful in forti- 
fying his assumed premises. 

The first remote cause of fevers noticed, is prolonged abstinence 
from food, and insufficient nourishment. Now we are free to admit 
that the first effect of this cause is not only weakened action of the 
heart, but of all the powers and functions of the system. This state 
of depression, however, is not a state of fever; on the contrary, it is 
universally considered one of our most efficient means to remove or 
alleviate an existing febrile affection. When abstinence is carried to 
the extent of producing disease, it does so not by weakening the ac- 
tion of the heart, which effect rather wards off for a time the evil, but 
by changing the character and qualities of the circulatory fluids, and 
rendering them so acrid and irritating as to produce not only most 
intense inflammation of the stomach and intestines, but also of other 
tissues of the system, which, when they prove fatal, destroy life 
amidst unexampled pain and suffering, as was evinced in the case of 
the criminal in France, who some years ago destroyed himself by 
voluntary starvation, and whose case was detailed with great minute- 
ness in the French journals at the time. M. Gaspard, inMagendie's 
Journal, Vol. I. p. 237, relates the effects of a most desolating famine 
which occurred in a part of France, in 1817, where the inhabitants 






Cooke's Pathology and Therapeutics. 129 

were constrained to divide with the cattle the herbage of the. fields, 
and to satisfy the cravings of hunger with all sorts of vegetable pro- 
ductions that fell into their way. The effects that ensued from this 
insufficient and gross nutriment were general serous diathesis with 
hydropic affections, without organic lesions of the chylopoietic viscera, 
and a remarkable exemption from fevers and febrile affections. 
These observations, with others of a similar character, that might be 
quoted, convince us that systematic writers have servilely copied from 
one another, without examining into its accuracy, that famine and 
moral causes are the frequent remote causes of fevers. We do not 
deny that they are sometimes predisposing and. perhaps even adjuvant 
causes, not only of fevers, but of many other diseases, by depressing 
the vital powers of the system, and thus rendering it more suscepti- 
ble to morbid derangement; but we think it would puzzle our author 
to adduce an instance where either of these causes has unaided pro- 
duced what he would call an idiopathic fever. 

The next remote cause mentioned is excessive bodily exertion. 
Undoubtedly this is often followed by great languor and debility, es- 
pecially when its effects terminate without further ill consequence, 
but when fever supervenes from this cause alone, it is usually during 
the state of excitement and tumultuous hurry of the circulation in- 
duced by the over-exertion of the muscular powers. The same remark 
applies to stimulant drinks as a cause of fevers. We are astonished 
that every physician's personal experience does not afford him the 
proof of this position. The constant attendant on taking an undue 
quantity of stimulating drink, is in fact a state of febrile excitement, 
which commonly ceases with the dissipation of its cause, and yet it 
will be hardly contended that that excitement has been preceded by 
weakened action of the heart. 

In making contusions from external violence, as falls and blows, 
the cause of fevers, the author has drawn his argument from the ana- 
logy of their first effects to concussions of the brain from the same 
causes. Here the same objection nearly recurs that was made when 
speaking of the effects of starvation. As long as the nerves of the 
part suffer from the benumbing or paralyzing effects of the external 
violence, there is no fever induced: when the injured part becomes 
the seat of irritation and fluxion, then fever is lighted up by this irri- 
tation, and not because the nervous system has been temporarily in- 
terrupted in its functions. In those cases where the brain is the 
suffering organ, inasmuch as its functions cannot be long suspended 
without fatal consequences, we are obliged to rouse the vital actions 
by the use of stimulants, although we are sensible that the after 

12* 



130 Cooke's Pathology and Therapeutics. 

effects of the injury will call for the most active depletory measures? 
and this too in cases where no concussion has been produced. 

Cold is one of the most constant and evident causes of disease, 
and the author endeavours to prove, chiefly from the facts furnished 
by Currie, that it invariably does so by weakening the action of the 
heart. This position is tenable to a limited extent only. Many facts 
and other authorities can be adduced to show that its modus operandi 
is far from being so simple as is here supposed. We have always 
considered the observations of the late Dr. Currie on the action of 
this power, as rather popular than profound. His work, indeed, is 
eminently practical, and in that way has been of great service in 
pointing out to physicians under what circumstances cold may be re- 
sorted to with safety for the reduction of febrile excitement; but other 
authors have treated of the operations of this agent on the system in 
a more philosophical manner. The work of M. Beaupre on this sub- 
ject is one of the ablest and most satisfactory that we have met with. 
His experience, and his opportunities for observation of its effects, 
which were very extensive, led him to assign to the operation of cold, 
effects differing greatly, according to the circumstances under which 
it was applied, its degree of intensity, and the condition of the sys- 
tem at the time. Sometimes, he says, it is refrigerant, sometimes a 
tonic, in other instances an astringent, then again a sedative like 
opium, -or a pure debilitant; whilst under ordinary circumstances it 
diminishes sensibility and increases contractility. Its impression, 
an effect overlooked by physicians, he considers to be decidedly sti- 
mulant to the living fibre. Dr. Cooke differs entirely from such 
views. He rejects even the modifying effects of other concurrent causes 
contended for by Currie, and pronounces its operation to be always 
directly debilitating, weakening the action of the heart and arteries, 
and to be indirectly stimulant only by being applied in that degree 
which is followed by reaction of the circulatory system. The most 
important circumstance attending the application of cold to the cu- 
taneous surface, is, in our opinion, its revellent effects on the inter- 
nal organs. In this way it seems to us to produce ordinarily febrile 
affections, a mode of operation wholly overlooked by our author, and 
not duly estimated by Beaupre, or any writer with whom we are ac- 
quainted. 

We think we have said enough to show that the author has not 
succeeded, to use his own language, "in tracing the remote causes 
through their chain of effects to the symptoms of disease," by assum- 
ing weakened action of the heart, from the nature of these causes, 
to be an indispensable precursor of all fevers, and we shall not, there- 



Cooke's Pathology and Therapeutics, 131 

fore, examine into the operation of the remaining causes with refer- 
ence to this subject. A more untenable theory, or one leading to 
more erroneous principles of treatment, we have not of late met with; 
but the time has gone by when such views can exert much influence 
over the minds of practical physicians, and we may safely turn it 
over to the fostering care of the author and his disciples: — 



-Velut inter ignes 



Luna minores. 
The three succeeding chapters on the remote causes of the epide- 
mics of hot climates are very interesting, and may be consulted with 
advantage by all who are seeking information on this department of 
the science. The principal circumstances which have attended the 
production of these fevers, especially in this country, are detailed 
with g^reat clearness, and fully establish the doctrine that all these 
fevers are produced by exhalations from vegetable substances under- 
going the putrefactive process, from the joint operation of a due de- 
gree of heat and moisture. The doctrines of Dr. Ferguson, that 
malarious exhalations are independent of vegetable putrefaction, and 
that in fact a paucity of water is one of the conditions of their for- 
mation, is ably confuted, chiefly from the doctor's own facts. 

The author, in his eagerness to exclude animal matter from any 
agency in the production of these epidemics, has, we think, passed 
over too lightly the proofs of the power of exhalations from putrid 
animal matter to produce febrile diseases. Numerous instances of 
their agency in this respect are not wanting in the annals of medi- 
cine,* and we ought not to reject them because they do not square 
with our own theoretical preconceptions, but rather endeavour to 
ascertain their diversity of effects, and in what the infecting material 
of each consists. This leads us to the author's next chapter, where 
he attempts to show that malaria is nothing more than carbonic acid 
gas. This opinion mainly rests on the assumption that like carbonic 
acid gas, it is a dense (heavy) air, and has the property of changing 
the blood when respired to a blackish hue; for the other arguments 
adduced, as its ready absorption by water and lime, its consumption 
in vegetation and generation by combustion, &c. are altogether gra- 
tuitous positions that need not detain us. As for the argument drawn 
from the similarity of effects of breathing an air highly charged with 
carbonic acid gas, and the malarious fevers, the analogy is much too 
loose and unimportant to be of any force. This consideration of the 
subject, indeed, rather makes against the theory, and if the agents 

* See an elaborate paper on this subject in the preceding' volume of this 
Journal. 



132 Cooke's Pathology and Therapeutics. 

shall hereafter be proved to be the same in both instances, we must 
attribute the diversity of results to some peculiarity of attendant cir- 
cumstances, which we are not enabled at present to appreciate. It 
by no means necessarily follows that malaria is a heavy gas, because 
it is more deleterious near the source of its origin than when wafted 
into the general atmosphere 5 for this may be owing to the very con- 
centrated state in which it exists before it is diffused abroad, and so 
greatly diluted, as to become comparatively innoxious. The second 
argument has more weight with us, without being entirely conclu- 
sive. We are gratified to find the experience of Dr. Cooke corrobo- 
rating the observations of Dr. Stevens, of Santa Cruz, (See Vol. VII. 
p. 505, of this Journal,) that the blood in these fevers is changed to 
a dark venous or black colour, although the experiments of Dr. 
Mitchell, [See his paper on the penetration of fluids in this Journal, 
Vol. VII. p. 36,) render it highly probable that this change may be 
owing merely to a deficiency of oxygenous gas in the air inspired^ 
still the remarks of our author on this subject, for which he could not 
be indebted to Dr. Stevens, are highly important, and may ulti- 
mately lead to a knowledge of the nature of these fevers, and of the 
malarious exhalations producing them. In the mean time, we must 
consider this branch of the inquiry to be sub judice, and withhold 
our assent from any theory that is not supported by more conclusive 
evidence than we have yet met with on this subject. The morbific 
cause may be carbonic acid gas, it may be carburetted hydrogen, sul- 
phuretted hydrogen, or arise merely from a paucity of oxygen gas in 
the air respired, or finally from a subtle material that has heretofore 
eluded the investigations of both physician and chemist. 

The chapter on the origin of winter epidemics is one of the most 
important and original in the work. These epidemics, which are 
usually a combination of bilious fevers with pneumonic disease, are 
considered to arise from the joint operation of miasmata and cold, 
and to be in fact a continuation of the autumnal epidemic modified 
by change of season. This connection has been casually noticed be- 
fore by writers, but without being applied to elucidate the cause and 
character of those malignant complications, so often exhibited in 
winter epidemics, and our author has rendered a service to medicine 
by bringing the subject more explicitly under consideration. We 
do not entirely coincide with him in the way in which the effect is 
brought about. We cannot conceive how the miasmata of October 
can operate conjointly with the cold of February as simultaneous 
causes. But perhaps we do not comprehend him, and he intends to 
say that the autumnal cause has produced a morbid condition of the 
system, which is aggravated into disease by the cold and wet of 



Cooke's Pathology and Therapeutics. 133 

winter: if so, we can see no reasonable objection to this view of the 
matter, except that it is insufficient to account for the occurrence of 
all winter epidemics which are characterized by bilious or gastric 
symptoms. We believe the winter constitution to be sometimes such 
as to give rise to these complications without the aid of previous de- 
rangement. 

The identity of the autumnal epidemic diseases is next insisted 
upon, but as this subject has been ably and learnedly treated by 
Rush and other writers to our entire satisfaction, and as no new ar- 
gument or illustration of force is adduced in corroboration of their 
views, we shall not repeat what is already familiar to our readers, 
We will remark, however, in passing, that we were somewhat sur- 
prised to find their identity urged on the ground that they were all 
preceded by weakened action of the heart; independent even of the 
evident absurdity that would flow from the admission of such a prin- 
ciple, yet one of the main objects of the work seems to be to prove 
that all fevers possess this attribute. Lest we should be thought to mis- 
represent the author on this head, we will let him speak for himself. 

" We infer the same from the identity, in all these fevers, of this new cause? 
weakened action of the heart, product h y the come remote cause. If we infer 
identity of the ultimate effects from the identity of the remote cause, and the 
justice of the inference is confirmed by observing that it is so far correct, we 
more confidently infer their identity from the identity of a cause nearer ttiau the 
remote cause. 

"It may perhaps be objected to this inference, that weakened action of the 
heart precedes variolous fever also, and therefore the identity of the autumnal 
fevers cannot be inferred from their being- all preceded by this state of the sys- 
tem. It is replied, that weakened action of the heart uniformly produces cer- 
tain effects called fever. Even when this cause is produced by a peculiar re- 
mote cause, the variolous virus, it produces its proper effect, fever, modified 
by certain effects peculiar to the remote cause. As weakened action of the 
heart, produced by this remote cause, uniformly produces corresponding ef- 
fects, a fever sui generis; so, when produced by another remote cause, mias- 
mata, we infer it will as uniformly produce a corresponding disease. Thus, as 
the confluent and distinct small-pox, proceeding from one remote cause, the 
mildest following inoculation with virus procured from a case the most malig- 
nant, are one disease; so, fevers, the mildest and most malignant, proceeding 
from one remote cause, miasmata, are also one." 

The remaining part of the first volume is occupied in treating of 
contagion as a remote cause of yellow fever, plague and typhus, of 
the origin of plague and of typhus, and of the identity of these diseases 
with malarious fevers. This part of the work contains little parti- 
cularly worthy of remark. The same facts and arguments are reite- 
rated, which have been many times before repeated, to show that 
none of these diseases are propagated by contagion, and that they are 



134 Cooke's Pathology and Therapeutics. 

all merely different grades of the same disease, arising from mias- 
matic exhalations, modified by attendant circumstances. We must 
enter our caveat against such sweeping conclusions. Ultraism in 
medicine is as pernicious as in politics, and has injured the best of 
causes. No American physician knows enough of plague to be able 
to lay down, with that certainty which science demands, the laws 
which controul its origin and propagation. On this subject, he must 
be content to receive his knowledge from the report of others; and 
every practical physician, we should think, must at times have had 
his doubts about the contagious character of typhus. ■ At any rate, 
the exhalations which produce this latter disease are generated under 
very peculiar circumstances, and are not to be confounded with 
marsh miasmata, any more than the time of its prevalence is to be 
identified with the ordinary occurrences of malignant bilious fevers. 
Had the distinction pointed out and inculcated by Miller, (See the 
appendix to his edition of Thomas's Practice,) been attended to, 
much of the difficulty which pervades this subject would have been 
explained away, without resorting to the doctrine of the unity of fe- 
vers: a doctrine which we could wish, for the reputation of Rush, 
had never received the sanction of his great name; and which here* 
as on all occasions, proves either too much or nothing. The author 
moreover elsewhere admits, as indeed every physician must, that 
fevers arise from a diversity of causes. As for the autumnal epi- 
demics of our country, the proofs of their miasmatic origin, arid 
non-contagious character, are ample even to the risk of overlaying 
the subject; but epidemic typhus, and no fever that is not epidemic 
is strictly entitled to the appellation, has heretofore been so extremely 
rare in this country, and some of the circumstances of its propaga- 
tion are so obscure and puzzling, that we cannot consider the ques- 
tion of its communicability as definitely settled. On the whole, 
therefore, we hold it to be the wiser course to lay down as positive 
only what our own experience, aided by that of others, warrants, and 
to leave to future investigators, more fortunately placed than our- 
selves, the task of elucidating such other points as fall within their 
actual observation. Cuvier has somewhere observed that the human 
mind supports doubts with difficulty, but it is precisely on that account 
that the learning to bear with them ought to be one of the principal 
studies of men of true learning. Had our author been impressed 
with this sentiment, he would have abated much of the confident air 
with which he advances and maintains his theoretical doctrines on 
this point, and his readers been spared much that we have passed 
over in silence. 

The second volume opens with an exposition of the effects of 



Cooke's Pathology and Therapeutics. 135 

Weakened action of the heart, which is considered, as we have seen, 
the immediate and invariable consequence of the operation of all the 
remote causes of febrile affections, and indeed of nearly all the dis- 
eases incident to the human frame. This weakened action of the 
heart, aided in some degree by the check given to all the secretions 
and excretions, is believed to produce an undue accumulation of 
blood in the venous cavity, (a term employed to denote the vena 
cava and its abdominal, thoracic, and cerebral branches, which are 
destitute of valvular apparatus;) and the different symptoms that oc- 
cur in the course of diseases from this cause, is traced to this venous 
congestion. Anatomical considerations are urged in proof of the 
great liability of the venous cavity to become congested with blood 
from diminished force of the heart's action. This consequence is 
attributed in a great measure to these veins being destitute of valves 
to aid in propelling the blood and to prevent its regurgitation, whilst 
the external veins are guarded against such accidents, by being fur- 
nished with them throughout their extent, to accomplish these pur- 
poses. Writers, it is true, generally assign this double function to 
the venous valves, but we were never able to conceive how they could 
act otherwise than as passive agents, to prevent the reflux of blood 
from extraneous causes. Hence, those parts only are provided with 
them, where such causes can operate, as in the extremities, and they 
are wholly wanting in the external parts of the head, where no lia- 
bility to such causes exists, and in the tri-splanchnic cavities, ex- 
cept the heart, muscles of respiration, &c. Could, internal venous 
congestions take place as easily as the author supposes, the human 
system would scarcely ever be without them. Even continued bo- 
dily exertion, a little severe, as it usually excites greater action pro- 
portionably in the voluntary muscles than in the heart, must con- 
stantly tend to push on the blood into the internal cavities, and thus 
give rise to undue accumulations in them, were such a cause suscep- 
tible of doing it, and was not counteracted by a law presently to be 
noticed. A reference to the experiments of Barry and Magendie, on 
the powers of the circulation, might also be adduced, to show that 
weakened action of the heart alone is incompetent to produce the 
effect here assigned to it; but we believe the position to be abun- 
dantly refuted by the ordinary occurrences of disease. Still it can- 
not be denied, that in all irritations of internal organs, there is from 
the very commencement of the derangement, an undue accumula- 
tion of blood in the affected organs, attended, in irritations of a cer- 
tain degree of intensity and importance, with a marked deficiency of 
that fluid in other parts; this, however, does not arise from the me- 



136 Cooke's Pathology and Therapeutics. 

chanical cause supposed, but from a vital law of the economy an- 
nounced by Hippocrates, in the memorable words, ubi stimulus, 
ibifluxus. The recognition of this law enables us to explain why it 
is that the blood deserts the external surface in morbid derangements 
of internal parts, without having recourse to weakened power of the 
heart's action, or even to the suppression of the secretions and ex- 
cretions. The effect of this latter cause to produce congestion, 
must at best be to a very limited extent; for if, during the first or 
atonic stage of fevers, there is little waste or evacuation of fluids, 
there is also little ingesta of any sort taken. Thirst comes on only 
on the accession of the hot stage, when there is more indication of 
arterial than of venous congestion. 

Having thus pointed out the manner in which he believes this ve- 
nous congestion to be brought about, the author proceeds to enume- 
rate the different symptoms that are its immediate consequence, 
mainly relying on the attendant circumstances of feeble pulse, and 
paleness and shrinking of the external parts, as indicative of this 
condition. The principal symptoms detailed, as arising from con- 
gestion of the venous cavity, are pulsation in epigastrio; palpita- 
tions; tumour, pain, heat, and increased sensibility in the abdominal 
region; oppressed, disordered respiration; head-ache, delirium, con- 
vulsions, and coma; serous effusions; hemorrhages; diminished and 
increased secretions and excretions; rigors, anorexia, nausea, and in- 
deed all the symptoms that usher in a febrile paroxysm, as well as 
many of those. which constitute its stage of excitement. A single 
remark will suffice to meet this part of our author's theory, and 
which we are convinced, every physician the least acquainted with 
disease at the bed-side, will coincide with us in holding as incontro- 
vertible. It is this. Nearly all these symptoms are commonly at- 
tended with a perturbed condition, and undue action of the heart 
and arteries, and that mere venous accumulation is not sufficient to 
account for any of them, under all the circumstances in which they 
are known to occur. Moreover, if the case were otherwise, and 
feeble pulse and pale skin were admitted to be the usual concomi- 
tants of these symptoms, it is begging the question to assume them, 
as indications of venous congestion, until the congestion was first 
shown to exist, and to be capable of producing such effects. What 
proofs does pathological anatomy afford of this venous congestion in 
febrile affections? Absolutely none whatever. A reference to the 
works of Louis and Andral, the ablest and best authorities on a ques- 
tion of this sort, will show that other and more permanent alterations 
of structure, occur in the great majority of cases, to account for the 



Cooke's Pathology and Therapeutics. 137 

febrile phenomena. But post mortem examinations are not allowed 
to disturb our author's reflections in pursuing a favourite object, or 
he would not consider pain, soreness, and heat of the abdomen, to 
arise from accumulation of venous blood, because they are attended 
with feeble pulse, and pale and cold skin. He assuredly cannot be 
ignorant that cases of peritonitis of the most intense grades of vio- 
lence, every now and then occur, in which the pulse is rendered ex- 
tremely small and feeble, scarcely to be felt, the skin cold and 
clammy, the external parts shrunken and bloodless, and all the vital 
energies of the system seeming to be concentrated in the abdominal 
region, without being able to excite those sympathetic symptoms 
which less severe inflammations exhibit. Should a practitioner un- 
der such circumstances, judging as our author did in a similar case, 
(see paragraph 1339,) that the symptoms arose from an accumula- 
tion of venous blood in the abdomen, give stimulant remedies, to 
rouse up the heart's action, the most disastrous consequences might 
ensue, and lead to a fatal termination of the disease. Nor is this 
the only instance in which inflammation may be mistaken for con- 
gestion. Nearly all diseases are made to consist in accumulation of 
venous blood, causing obstruction to the blood's circulation. Exter- 
nal inflammations, derangements of the nervous system, and the 
morbid condition of the digestive functions, &c. are considered as 
depending on the same state, thus overlooking, in a great measure, 
irritation of the living fibre, the active agent of disease, in favour of 
a mechanical and passive cause. 

As most diseases are considered to be the consequence of accu- 
mulation of blood in the venous cavity, from the operation of remote 
causes weakening the action of the heart, they are divided in con- 
formity with these views and comprehended under the following 
heads. 1st. Diseases attended with increased action of the heart 
without local affection, as simple fevers. 2d. Diseases without 
either increased action of the heart, or local affection, as dyspepsia. 
3d. Diseases with increased action of the heart and local affection, 
as pleurisy. 4th. Diseases without increased action of the heart 
and with local affection, as the consequences of a bruise, or fall, 
without an attendant fever. We do not see any practical advan- 
tage to be derived from this arrangement, which must besides vary 
in its application with the theoretical views of each that shall adopt 
it, and for ourselves, we confess that we are unable to form any pre- 
cise idea of a catalogue of diseases arranged in conformity with it. 
We shall therefore pass on to the consideration of the therapeutical 
department of the work. 

No. XV.— May, 1831. 13 



138 Cookers Pathology and Therapeutics. 

Therapeutics. — The principles of treatment for all diseases arising 
from an accumulation of blood in the venous cavity, are comprised 
in four general indications. 1st. To remove the remote causes 
operating on the heart. 2d. To excite the weakened action of the 
heart and support its action. 3d. To reduce the quantity of blood 
accumulated in the venous cavity. And 4th. To reduce the action 
of the heart in the stage of excitement. The mode of attaining the 
first is pointed out by the nature of the remote causes; the second 
may be accomplished in febrile affections, by warm drinks, warm 
applications externally, and the exhibition of emetics to throw the 
blood on the surface, and in intermittents, during the apyrexial period, 
by giving permanent stimulants and tonics. The author, however, 
prefers in these latter diseases, as well as in chronic affections, the 
repeated use of cathartic medicines, as calomel, aloes, rhubarb, 
jalap, scammony, &c. given during the time of the lowest stage of 
weakened action, in order to keep up and stimulate the heart's ac= 
tion, and to produce their evacuant effects in the after stage of ex- 
citement. The cold bath may be resorted to with the same inten- 
tion; the reaction induced being often sufficient to enable the heart 
to throw off its accumulated load. The third indication may be ful- 
filled by the subtraction of blood, but here also the chief dependance 
is placed on the free and daily use of the cathartic medicines above 
enumerated, given for their chylagogue effects, so as to produce full T 
consistent, dark-coloured or bilious discharges, and repeated to the 
entire removal of the diseases. The fourth indication is met by 
bleeding, purging, and cold applications. Little reliance is placed 
on promoting discharges from any other organs than the chylopoietics r 
and nauseating medicines are rejected, although admitted to be of 
considerable efficacy, because they are disagreeable in their opera- 
tion. Such are the therapeutical principles, and if the pathological 
views are, as we have deemed them, hypothetical, the consequences 
of these practical precepts will be found we fear, to be something more 
than imaginary. This constant resort to reiterated purgation, not 
to be restrained even after it has induced bloody discharges, cannot 
be otherwise than disastrous; sometimes immediately so, by aggra- 
vating the already irritated state of the prims viae; and in other in- 
stances, laying the foundation of future ailments, by the production 
of chronic derangements. This purging is quite a passion with our 
author, and employed in nearly all occasions, and to answer opposite 
and contrary indications. To check menstruation when too pro- 
fuse and to bring it on when suppressed or scanty. He never fears 
any untoward effects from the most active and stimulating materials 



Cooke's Pathology and Therapeutics 139 

of this class of remedies, but gives them with the same confidence 
in uterine haemorrhages in the latter months of pregnancy, and in hae- 
morrhages of the intestinal canal, as others would employ them to 
relieve an impacted state of the bowels. It would seem that in his 
view hardly any other medicinal effect is capable of removing dis- 
ease. Has the exhibition of cinchona or the nitrate of silver cured 
a case of dyspepsia, it was by acting as a purgative. Has tansy 
or lime water warded off the gout, or calomel and squills removed, a 
dropsy, it was still by their purgative qualities without reference to 
their operation on the other emunctories of the system. 

It is unnecessary to enter into details on the pathology and treat- 
ment of individual diseases. They are of course in conformity with 
the general principles: accumulation of blood in the venous cavity, 
the all-sufficient cause, and for treatment, blood-letting to relieve 
this accumulation, when the strength and fullness of the pulse will 
warrant its employment; but in general the great reliance is on pur- 
gation, repeated again and again without looking to any ill conse- 
quences that such a persevering course may induce. The infatuation 
with which the use of pills of aloes, jalap and calomel, is persisted 
in day after day, till the patient has taken in a case of dyspepsia, not 
grains, but ounces, and we might almost say, pounds, is really in- 
credible and consternating.* 

Well may the author observe that his treatment is, as far as 
he knows, new! Hamilton, and every writer with whom we are ac- 
quainted, are mere slop doctors, compared to him. Even the famous 
Leroy, of purging memory, {see his Medecin curalif,) must quail 
before him, and wonder how the stomach and intestines of our west- 
ern brethren can withstand such rough treatment. The extent to 
which this preference for purgatives is carried may be judged of by 
the fact, that the repeated use of cathartics is preferred to quinine in 
the treatment of intermittents, and their daily use persevered in, in 
continued fevers, in despite of intestinal haemorrhages, to the entire 
extinction of the disease. 

However the late writers on fevers may differ concerning their 
seat and local character, all who have made pathological anatomy 
the basis of their investigations, and the opinion of none others de- 
serve weight in settling these questions, accord to the digestive tube 
an important agency in the production of the febrile phenomena, or a 

* la our periscope, under the head of American Intelligence, we have in- 
serted two cases of dyspepsia related by our author. They afford a specimen 
of his purgative practice in that disease. 



140 Cooke's Pathology and Therapeutics. 

morbid condition of some part of it, which has supervened during the 
course of the disease. We must be regardless of these conclusions, 
not to be invalidated by hypothetical reasonings, as well as the happy 
effects which we have witnessed from the adoption of such views in 
the treatment of fevers, before we can be brought to consider the 
combined application of such stimulants as calomel, aloes and jalap, 
to an already irritated part, can be void of danger, and to be pre- 
ferred to a soothing ab-irritant plan of treatment. The influence 
which pathological anatomy now happily exercises over the minds of 
physicians will not permit them to retrograde to the ancient routine 
of stimulant treatment, and we do not apprehend that such practical 
precepts as are inculcated by our author can long stand their 
ground, even within the sphere of his influence against the advancing 
triumphants of actual science. 

We have given enough of the contents of these volumes to enable 
our readers to estimate their general character and value. The 
same zeal and undoubting confidence in advancing novel doctrines 
pervades every part of them. All is plain to our author, even the 
obscurest questions in physiology. The arteries are made to termi- 
nate directly into veins, in Some instances with sensible motion. 
The glands are nothing more than continuations of arteries into 
veins, giving rise to excretory capillaries exactly at their point of 
junction. What has been taken for fibrous structure of the brain is 
simply medullary tubes for the conveyance of the excretory nervous 
fluid into the nerves, which are equally of tubular structure. He 
may rest assured that such doctrines are not now to be received on 
the ipse dixit of any one. They must be tested by long and patient 
investigation and comparison with all the known phenomena of vital 
action before they can merit to be thought more than mere conjec- 
tures. The science of medicine has within these last twenty years 
undergone great and salutary changes. Hypothetical reasonings 
have given place to facts rigidly deduced from experiment and ob- 
servation; but this change seems not to have affected in any degree, 
the work before us, which is essentially a production of the last cen- 
tury; with the same proneness to theorize, and to rest, for the sup- 
port of particular views, on the authority of great names, which cha- 
racterise the productions of those times. This similarity is not, we 
suspect, accidental. At any rate we have no where the least inti- 
mation that the author is acquainted with the labours of Parry, 
Armstrong, and Abercrombie, of Britain, or of those of Louis, 
Andral and Laennec, of France, with a host of others, who have 



Pharmacopoeia of the United States. 141 

contributed to base medical science on principles unknown to former 
times. 

In closing our observations we must be permitted to remark, that 
we have never performed our critical labours with greater reluctance 
than on the present occasion. We have found so much to dissent 
from and to censure, that we have sometimes feared that it might be 
thought that we were rather impelled by personal pique than a proper 
regard for the interests of science; and yet the author is personally 
unknown to us, and we have only been led, if we know ourselves, to 
deal thus freely with his opinions, because we apprehend that his 
talents, his learning, and the eminent station which he occupies were 
calculated to disseminate his unsound doctrines over a widely ex- 
tended country. When we next hear from him, we hope to have 
more. to commend, and an opportunity of aiding him to propagate 
sound and rational views of a science so nearly allied with the best 
interests of society. CD, 



Art. XIII. The Pharmacopoeia of the United States of America. By 
authority of the National Medical Convention, held at Washing- 
ton, A. D. 1830. Philadelphia, John Grigg, 1831. 

The Pharmacopoeia of the United States of America. By authority 
of the General Convention for the formation of the American Phar- 
macopoeia, held in 1830. New York, S. Converse, 1830. 

IF the medical and scientific world were restricted to the most sim- 
ple modes of expression and inter-communication, if we possessed, 
for example, but one nosology, but one system of natural history, but 
one language of chemistry and pharmacy, it is obvious that the books 
which treat of those sciences, would be greatly simplified; that the 
labour of learners would be abridged, and much confusion prevented 
among those who respectively teach, or cultivate, these departments 
of knowledge. Of this fact, the public are so well aware, that at- 
tempts have been many times made to establish in these sciences, 
standards of definite expression. Sometimes under the sanction of 
governments, sometimes from the influence of popular writers or 
teachers in science, and sometimes from the conventional authority 
of delegated bodies, a common language has been introduced, and 
obtained a degree of currency, which though seldom universal, has, 
nevertheless, been sufficiently extensive to produce a full proof and 
conviction of its utility. 

13* 



142 Pharmacopoeia of the United States. 

Unhappily, however, in those studies, the subjects of which are 
most multifarious and complex, and which therefore stand most in 
need of precision in their nomenclatures, an inexplicable confusion 
of language still exists. Mineralogy, zoology and botany, particu- 
larly the two latter, in themselves no trifling subjects of labour, have 
been rendered to most persons, absolutely insurmountable, by the 
cumbrous load of synonyms, which has been gradually accumulating 
upon them, under the agency of successive reformers. The Latin 
language, once the common medium of intercourse for the learned 
of all countries, has itself become a sort of Babel, furnishing not un- 
frequently, a dozen incongruous names for the same object. And 
since neither Napoleon nor Nicholas, nor any general congress for 
the pacification of Europe, has taken in hand the reconciliation of 
conflicting terminologies, the republic of names still remains at the 
mercy of every innovator whose new colours may attract partisans 
and disciples, and increase the anarchy already existing. 

It is therefore sufficiently evident, that the sciences which we have 
mentioned, need retrenchment, quite as much as extension; and 
were it not for the fact, that certain nomenclatures have become in- 
corporated with books more useful than themselves, it would be a 
happy circumstance, if all of them, save one, could be consigned to 
oblivion. To determine what one in each particular case, should 
supersede all the rest, might be as delicate an affair as to elect a pre- 
sident of the United States. But it is not the less true, that one, 
even though deficient and unacceptable, would be far better than 
many. 

Pharmacology, considered not only as a science, but as a medium 
of communication for two extensive professions; particularly needs 
simplicity and precision of language. It likewise requires that its 
expressions should be generally intelligible, an advantage which can- 
not be secured, except by the introduction of a general standard, 
regulating the names, as well as the selection and modification of its 
subjects. On this ground, it is presumed, there is no variance ot 
opinion. But when we arrive at the question, what the standard 
shall be, and who shall appoint it, the charm of unanimity is very 
apt to dissolve. 

It is not difficult to frame a competent pharmacopoeia, which shall 
be abundantly adequate to the wants of the medical community. 
But to devise a plan by which its general adoption shall be secured, 
is a task which experience has proved to be attended with no ordi- 
nary difficulty. Local partialities, and an unwillingness to receive 
the supposed dictation of others, have, in more cases than one, frus- 
trated the best contrived plans for promoting a general accommoda- 



Pharmacopoeia of the United States. 143 

tion. And since indisputable perfection is not to be expected in a 
pharmacopoeia, there will always be found a spirit of hypercriticism, 
ready to consider trivial defects, as reasons for rejecting a public 
good. 

We hold it to be a maxim, that one standard of pharmacy, if sanc- 
tioned throughout a whole country, even though it be an imperfect 
one, is far more promotive of public convenience than a number of 
more learned and perfect ones, existing simultaneously. The late 
autocrat, Alexander, ordered his Scotch body-surgeon, Sir James 
Wylie, to prepare a Pharmacopoeia Rossica, which he introduced by 
an ukase throughout his extensive dominions. This work, a copy of 
which has reached us, appears to be sufficiently respectable. But., 
without entering into its particular merits or demerits, we will ven- 
ture to presume that the subjects of his hyperborean majesty have been 
enabled to compound and swallow their drugs with equal effect, and 
far less trouble, than those of the king of Great Britain, speaking in 
the tongues of three different colleges. 

If the business of making a pharmacopoeia could be commenced 
de nova, without reference to any of the stand-ards now existing, the 
great question presented in regard to nomenclature would be, whether 
names should be scientific, that is, in some measure descriptive of 
the origin, character, and composition of medicines; or whether they 
should be arbitrary, having no such reference or import In the former 
case, the names would be more expressive, and better suited to the 
dignity of science; in the latter they would be more permanent, from 
not being connected with any fluctuating medium. 

To illustrate these positions, let us observe the revolutions througli 
which a single substance has been obliged to pass, in order to keep 
pace with the progress and improvements of science. Since the dis- 
covery of calomel, that article has been reformed by at least a score 
of successive appellations. In the figurative language of alchemy, 
it was known by the names of draco mitigatus, aquila alba, manna 
metallorum, &c. As chemistry grew somewhat more definite as a 
science, this substance became mercurius dulcis, and mercurius dulcis 
sublimatus. Under the regime of Lavoisier and his cotemporaries, 
it was a muriate and a submuriate; and after Davy and Gay Lussac, 
became a chloride and a proto-chloruret. Lastly, as if the gentleness 
of its character was to produce a reconciliation of extremes, the miti- 
gated dragon of antiquity has become a mild chloride of mercury. 

On the other hand, when a nomenclature has been perfectly arbi- 
trary and divested of scientific relations, it has been proportionably 
durable and constant. Like the words engrafted on a national Ian- 



144 Pharmacopoeia of the United States. 

guage, its origin may be vague and accidental, yet the public conveni- 
ence prevents it from falling into disuse; and though it might, perhaps, 
be susceptible of reform, yet the benefit would not compensate the trou- 
ble. In regard to pharmacology, there is one language alone which 
has remained permanent amidst mutations, and which a hundred 
years have not been able to shake from its basis — we mean the lan- 
guage of commerce. This language, which is for the most part ar- 
bitrary and accidental, has seen many pharmacopoeias rise and fall, and 
is now quite as likely as any one of them to last for a century to come. 
The simple names of opium and alum, of calomel and camphor, have 
never yielded to any periphrastic method of expressing the same 
things. Corrosive sublimate refuses to be modernized, and the salts 
of Epsom and Rochelle maintain their ground against all chemical in- 
terference. The combined learning of two hemispheres is unable to 
prevail against copperas and cream of tartar, and the manufacturer 
and merchant still continue to make, sell, and buy their tartar emetic 
without troubling themselves to inquire whether it is a "tartrate" or 
a "cream -tartrate," or neither. Nay, in some instances the vulgar 
appellations have turned the tables upon the classical and scientific, 
and the homely name of potash has dictated to the learned their more 
elegant potass and potassium. 

To combine in practice the expressiveness and precision of one 
language with the durability of the other, though very desirable, 
would, from the nature of the subject, be impossible. Yet an ap- 
proach may be made to the advantages of both, by adopting in the 
first instance a descriptive language founded on the existing state of 
science at the time,' and afterwards to declare it perpetual, or at least 
to establish it in force during a long term of years. We should thus 
possess a medium of communication in itself entitled to respect, and 
rendered more valuable by the prospect of being permanent. 

It appears to us, that the stability of pharmaceutical language is 
a consideration of quite as much importance as its improvement. 
Great changes, in regard to any prevalent system, can seldom be 
effected without doing violence to established habits and preferences of 
the community. An apothecary whose drawers are labelled with the 
legitimate nomenclature of the day, and a physician who for a score 
of years has employed a uniform phraseology in his prescriptions, are 
not compensated by any trifling advantage, for the risk and trouble 
of an entire change. Wherever, therefore, it appears that a uniform 
system is extensively established in any country, it is incumbent on 
the friends of science to oppose all unnecessary deviation from the rules 
it prescribes. If the general progress of other sciences has been such 



Pharmacopoeia of the United States. 145 

as to require that pharmacy should be made to keep pace with them, 
its improvement ought to consist as far as possible in additions, 
synonyms, and commentaries; but not in great or violent changes. 
It is fortunate for the science of anatomy that its distinctive names 
have been handed down from one generation to another with so little 
alteration; and we believe no reformer at the present day would 
obtain many proselytes, who should propose to abolish its nomencla- 
ture, because os sacrum, ossa innominata, and similar names, are ab- 
surd, misplaced, or unscientific. 

In regard to preparations and compositions, it may often happen 
that improvements are necessary in pharmacy, to promote the eco- 
nomy and uniformity of certain results. Such changes are highly 
proper, provided they do not interfere materially with the standard 
of strength which has been previously current. But great changes 
in the strength of medicines may generally be regarded as pernicious, 
serving to perplex apothecaries and deceive physicians, if not to kill 
patients. It is to be regretted that in the different pharmacopoeias 
which have been published among us, there are operative medicines 
bearing the same names, in some of which the strength is double that 
of others. As to the more complex medicinal formulae which crowd 
our books, it will be found that most of them owe their place in the 
shops to some fashion, or some traditional celebrity, rather than to 
any exclusive fitness or virtue; and we may perhaps get a true idea 
of their value from the consideration, that if, by any means, the 
knowledge of the whole of them should be lost, it is not probable, in 
the doctrine of chances, that one in fifty would ever be reinvented. 
Yet, since the prevailing traffic requires that they should continue to 
be made and sold, it is important for those who consume them, that 
they should be exempt from fluctuations of character. 

In the United States, previous to 1820, there was no uniformity 
of pharmaceutical language. Pharmacopoeias, indeed, had been 
adopted by medical bodies, in Massachusetts and some of the other 
states; and Dispensatories, both foreign and native had been pub- 
lished among us. But in the year referred to, an effort was made, by 
which the consent of a great majority of the medical institutions of 
the country was obtained, for a plan of a national pharmacopoeia. 
This it was confidently hoped, by introducing a current language 
throughout the country, would do away the confusion which then 
prevailed, and offered to the parties concerned, a facility of inter- 
communication, corresponding to that which results from a common 
system of coinage, or of weights and measures. A numerous and 
highly respectable delegation was appointed, from most of the prin- 



146 Pharmacopoeia of the United States. 

cipal states, a part of whom met in the city of Washington, at the 
appointed time. 

It may here be proper to enquire what such a convention could 
reasonably be expected to do, and what it was their duty to do, under 
the circumstances in which they were placed. Coming together from 
remote places, and holding their session at an inconvenient sacrifice 
of time and expense, it was not to be anticipated that they would in- 
stitute an original investigation of the whole subject. The ordeal 
of an experiment upon every doubtful subject, would have involved 
a labour of months, and perhaps of years. It would not reasonably 
be expected that they would produce a pharmacopoeia, which should 
be better than any which previously existed. A debating assembly 
would be far less likely to do this, than a competent individual in his 
closet. Yet the convention possessed the power to confer a great 
good $ a power which no individual is likely to obtain, that of intro- 
ducing order in the place of confusion, and law instead of anarchy. 

Under these circumstances, it was incumbent on them to produce, 
or sanction, some standard of pharmacy which should be adequate to 
the wants of the community. It was not very material what one, 
among many standards, they should adopt as their basis. They 
might have selected the Edinburgh Pharmacopoeia, which, though 
prolix in its expressions, was at that time more current than any 
other in the country. Or they might have taken the London Phar- 
macopoeia, dogged as it has been by Mr. Phillips, and this would 
have served very well as the ground-work of a useful book. Or they 
might endeavour to frame a system of their own, which, in some 
respects, might be superior to its predecessors, or at least better 
adapted to the customs and wants of our own country. The last 
plan was decided on by the convention, under the expectation, 
doubtless, that it would be more acceptable to their constituents. A 
programme of a pharmacopoeia prepared by the college of physicians 
in Philadelphia, was adopted as the ground-work, and after being va- 
riously modified and augmented, was referred to a committee, with 
instructions to publish it. 

It must necessarily happen that a work emanating from so many 
discontented sources, a part of whose contents must, from the nature 
of the case, be the result of compromise among the parties concerned, 
rather than of satisfaction to any of them ; would be in some respects 
imperfect, disconnected, and redundant. Nevertheless, if it was on 
the whole better suited to the occasion than any other work actually 
existing, the public were bound to receive it with complacency, as 
the only standard which could ever become general among us. And 






Pharmacopeia of the United States. 147 

if criticisms were needed to point out the faults which it contained? 
they should have been made in a spirit of manliness and liberality., 
such as would have promoted the gradual reform and perfection, 
rather than the overthrow of the work. But several of the journals 
thought otherwise, and the pharmacopoeia was obliged to undergo an 
ordeal, the severity of which far exceeded its deserts. The spirit ot 
criticism was pushed with a zeal not according to knowledge, and in 
many instances the ignorance of the commentator, rather than the 
defects of the book, produced a reprobation of its contents. Never- 
theless, the pharmacopoeia was received, willingly by some, and re- 
luctantly by others, and became, we have reason to believe, the 
prevailing standard, or at least, more prevalent than any other 
throughout the United States. 

It was to be hoped, that when the period should arrive, which had 
been assigned by the convention for a revision of this work, a suffi- 
cient unanimity of sentiment would have prevailed, to direct into one 
channel whatever amount of skill and experience might be volun- 
teered for its improvement, either by societies or individuals. It 
appears that numerous societies, in different parts of the union, 
feeling an interest in the revision and confirmation of the pharma- 
copoeia, had appointed delegates to attend the expected convention at 
Washington in 1830. A part of the delegates thus designated were* 
agreeably to the provisions made in 1820, returned to the presiding 
officer of that year. But a greater number, who had not been 
formally returned, proceeded to Washington at the appointed time, 
and having organized a convention of such delegates as were pre- 
sent, and invited the cooperation of other medical gentlemen of emi- 
nence then in the city, proceeded to take measures for the republi- 
cation of the work. In the mean time, a part of the delegates w1h» 
had been officially returned to the former president, influenced 
either by convenience, or by the smallness of their numbers, deter- 
mined not to convene at Washington, but held a meeting in New 
York, where they also proceeded to take measures for republishing 
the pharmacopoeia, having likewise invited the cooperation of other 
medical gentlemen of note. Out of this want of concord have risen 
up two pharmacopoeias, neither of which can strictly claim to be, by 
lineal descent, the legitimate heir of the original work; one, proceed- 
ing from a body not formally declared elected to the convention at 
Washington; the other, from a body who did not convene at Wash- 
ington at all. We regret, during the long period of preparation, 
in which the proceedings of each party must have been known to 
the other, at least in a degree, that some compromise was not effect- 



148 Pharmacopoeia of the United States. 

ed, so that the objects of both might be effected, with less trouble to 
themselves, and less expense to the public. It was not indeed in 
the power of the delegates at Washington to correct the original de- 
fect in their mode of election, but it was in the power of the dele- 
gates of New York to have gone to Washington, and there to have 
invited the cooperation of the other delegates present, especially as 
they appear not to have been afterwards fastidious in associating with 
their own body, undelegated individuals. Even after the original 
meetings had taken place, a slight spirit of conciliation in one or 
both parties, (we know not which was wanting in this respect,) would 
have produced harmony and unity in the end. 

As things now are, it appears to us that the two works must stand 
upon their respective merits, as pharmaceutic compositions; and the 
public are called on to decide, whether either, and if either, which 
one, is entitled to be received as the national standard. And here, 
if it be asked what constitutes fitness or excellence in a pharma- 
copoeia, we should answer simply, that such a work ought to contain 
and identify the medicines which are commonly used by physicians, 
that its preparations should be scientifically composed, that its lan- 
guage should conform to the most current language of the day, and 
that it should be complete as a system in itself, that is, should have 
a correspondence between its own parts. In these respects we think 
the Washington Pharmacopoeia has greatly the advantage of its com- 
petitor. We observe in its list of materia medica, comparatively 
few alterations of names, and these are made mostly in conformity 
to the present language of chemistry. In the New York edition, 
the changes are exceedingly numerous, the new names being taken 
partly from the London Pharmacopoeia, and partly invented for the oc- 
casion, so that the book has the aspect of an edition of some other 
work, rather than of the American Pharmacopoeia. The references 
to authors, which are considered necessary by most pharmacologists, 
to identify the substances intended, are wholly omitted in this work. 
In regard to completeness and accuracy, the work of the Washing- 
ton convention is prepared with much care and science, and with a 
correspondence of its different parts. In the New York edition we 
find a want of unity, such as attends hasty preparations, and a dis- 
cordance often recurring, between the names of the articles them- 
selves and those of their preparations. 

In regard to the latter work, knowing the difficulties which attend 
this species of composition, and entertaining a high respect for the 
character of the gentlemen concerned, we forbear to fill our pages 
with commentaries on its redundancies and discrepancies. We shall 



Pharmacopoeia of the United States. 149 

not therefore complain because Burgundy pitch is inserted twice un- 
der different names, in the materia medica, nor because the sulphates 
of quinine and morphine, figs, prunes, and some other articles re- 
quired in the preparations, are not inserted in the materia medica at 
all. These things must be corrected with their pens, by those who 
may employ the book. On the other hand we are happy to perceive 
some improvements on the edition of 1820 in the greater accuracy 
of the chemical nomenclature, and in the introduction of some useful 
formulas. We think however that retrenchment, in the old work, 
was much more needed than augmentation. 

Believing that the pharmacopoeia produced by the Washington con- 
vention, being a more elaborate, accurate, and finished work, will 
eventually become the standard of the country; we propose to enter 
somewhat more at large into the consideration of its contents. This 
we shall endeavour to do with the impartiality which the subject 
ought to receive. 

In their preface this convention express their reasons for adopting 
as their basis the Pharmacopoeia of 1820, a work having many incon- 
veniences and defects, but at the same time many claims to approval. 
In its general outline, say they, and prominent features, it will bear 
a favourable comparison with the best pharmacopoeias of Europe, 
and it is only in filling up, that improvement is demanded, or ad- 
missible. The changes therefore which have been made under the 
authority of the late convention, embrace the materials and minor 
arrangements, without extending to the general plan. In preparing 
for the press the present revised edition, the new convention inform 
us, that much labour has been expended, and every part of the work 
submitted to the most strict and rigid scrutiny. Every accessible 
pharmaceutic authority has been consulted, and the accuracy of pro- 
cesses has been frequently tested by a practical investigation; the 
several departments have engaged the attention of individuals pecu- 
liarly qualified by their previous studies, and the whole has passed 
the examination of pharmaceutists of acknowledged eminence in 
their profession. 

Considering how difficult it is to induce persons of the necessary 
competency to engage in gratuitous labours with perseverance and 
fidelity, we are happy that the individuals concerned in the present 
revision, have devoted themselves with such singleness of purpose to 
the perfecting of the work. From our knowledge of the amount of 
labour actually bestowed on it, and from the internal evidences 
which it bears of extensive enquiry and precise examination, we 

No. XV.— May, 1831. 14 



150 Pharmacopoeia of the United States. 

doubt whether any future convention will present us with results 
more deserving of the public confidence. 

In pursuance of the plan of the former edition* and for reasons 
which it is not necessary here to repeat* the pharmacopoeia is written 
out on opposite pages in Latin and in English. The classical latinity 
of the London Pharmacopoeia is adopted as a standard, and by keep- 
ing this in view, a unity of style is preserved throughout the book. 
We see no cause to be dissatisfied with the general purity and ele- 
gance of this language ? though in one case, we observe, the conven- 
tion have erroneously followed the London example, in using the 
genitive "rosmarini," and ablative "rosmarino," instead of the 
undoubted rorismarini, and roremarino, sanctioned by Horace, 
Columella, and other classics. 

In regard to names, the convention informs us in their preface, 
that for reasons which they discuss at length* they have adopted the 
modern chemical nomenclature, in which the names are expressive 
of the composition of bodies. This was in most cases done by the 
framers of the former pharmacopoeia, but in the present edition an 
attempt has been made to bring the nomenclature more completely 
into accordance with the best scientific usage. Thus we have chlo- 
ride of sodium^ instead of muriate of soda; ferrocyanate of iron, in- 
stead of prussiate of iron, &c. In a few instances, however* to avoid 
great circumlocution, a pharmaceutical name is retained in the place 
of a more expressive chemical appellation, as in the case of alumen, 
hydrargyrum, ammoniatum, &c*. In conformity with the present 
language of chemistry, the proportional composition of bodies, it ap- 
pears, is intended to be expressed, and we have among other things 
a bicarbonate of potass, and a bicarbonate of soda. But this intention 
is not always executed throughout the work, which seems to us a de- 
fect in uniformity. The substance called by this convention sulphate 
of copper, is a bisuiphate, and ought so to be called in a chemical 
nomenclature, since there is another sulphate, composed of one 
equivalent of acid and one of peroxide of copper, which is precipitated 
by adding pure potass to the solution of the bisuiphate above men- 
tioned, in a quantity insufficient for separating the whole of the acid. 
We know not for what reason it has been thought proper to omit* 
as synonyms, certain commercial names of common usage, while 
others of much less frequent occurrence, are retained. The student 
of pharmacy who would know what is meant by Epsom salt, Glauber's 
salt, blue vitriol, and other names which meet him in the daily price- 
current, must seek for information in other books, than the American 
Pharmacopoeia. These names being international, and long establish- 






Pharmacopoeia of the United States. 151 

ed, cannot, we think, with propriety be given up, in a work of gene- 
ral pharmacy. 

In the nomenclature of substances derived from the vegetable 
kingdom, the work before us adheres to the simple and appropriate 
plan of the first edition, that of using in all practicable cases, a 
single word for the name of the drug, leaving its nature and origin to 
be defined in the opposite column. This peculiarity of the American 
Pharmacopoeia is one of its leading excellencies, and one which the 
New York convention seem to have acted unwisely in abandoning. 
Most of the names used in other pharmacopoeias, to express vegetable 
substances, are either unwieldy in their length, or improper in their 
application. Thus the drug assafoetida is called by the Edinburgh 
college gummi resina ferulee assafoetidae, a name which is highly de- 
scriptive, but inapplicable to common use. By the London college 
it is called assafoetidae gummi resina; but as the term assafoetida 
alone is not the name of any plant, in any botanical system of the 
present day, the whole name is incorrectly composed. The simple 
name of the drug, assafoetida, is undoubtedly better than either. In 
like manner columbo may be called by the simple name colomba, or 
by the circuitous name cocculi palmati radix, but not calumbse radix, 
for there is no such plant as calumba. The American Pharmacopoeia 
Jias another advantage in using simple names, whenever the drug 
happens to be derived from several plants, as camphor, senna, rheum 
and aloe, or from several animals, ichthyocolla. In the present edi- 
tion, a slight variation is made from the former, in using the Latin 
name of the article always in the singular number; as cantharis, caryo- 
phyllus, prunum, instead of cantharides, &c. This method preserves 
uniformity, and is supported by the usage of Celsus in similar cases. 
As in the former edition, the materia medica list is divided into 
two columns, the first of which contains the officinal name of each 
article, in Latin and English, together with occasional synonyms; 
while the other defines the substance intended, and gives explanatory 
references. This part of the work gives evidence of a laudable de- 
gree of care and research, yet we notice a few minor things deserving 
of remark. The substance called lupulin, derived from the hop, is 
defined "strobilorum pollen." As the word pollen has, in vegetable 
physiology, a specific meaning, it would have been better to have 
used some other name, to express powder. In the Latin, lupulia as 
used by the New York convention, is more consonant to morphia and 
quinia, than lupulina. We see no reason for giving up spermaceti, 
the universally received name, both in chemistry and commerce, and 



152 Pharmacopoeia of the United States. 

substituting cetaceum of the London college, a word which is neither 
more classical, nor more definitive. Scabious applied to erigeron, is 
a provincial misnomer, that name belonging only to Scabiosa. 

In regard to preparations, the convention considering this the 
most extensive and important part of the work, have devoted to it a 
greater share of their attention. They inform us that examination 
has been carried into all its parts, and not a single process has been 
allowed to escape a close scrutiny. One of the most prominent de- 
fects of the original pharmacopoeia was a want of uniformity, both in 
the manner of conducting the processes, and in the style of describ- 
ing them. This arose from the variety of sources from which mate- 
rials were drawn, and the want of due time to remould and shape 
them, so as to produce a harmonious whole. In the present edition, 
an effort has been made to supply these deficiencies, and to produce 
uniformity of language, as well as correspondence and unity of de- 
sign, in the different parts of the work. In the selection of the pro- 
cess for each preparation, two principles are stated to have governed 
the choice of formulae, independent of their intrinsic merit, which, 
when superior, has always been allowed a predominating influence. 
"When two or more methods of preparing the same compound, equally 
meritorious in themselves, have come under consideration, that has 
been preferred which has united in its favour, the widest prevalence 
in this country, and the sanction of the majority of the British phar- 
macopoeias. It is considered highly desirable, that uniformity in the 
preparation of medicines should everywhere prevail, for the benefits 
accruing from the mutual interchange of the medical writings of dif- 
ferent civilized nations, must be greatly affected by any material dif- 
ference in the nature or composition of the remedies employed. This 
remark is especially applicable to Great Britain and the United 
States, and to all countries where the English language is generally 
used. It is a duty, therefore, say the convention, which we owe to 
the cause of pharmacy, to throw our weight into the scale which al- 
ready preponderates, and thus contribute to the production and 
maintenance of the desired uniformity. 

In those cases where the chemical formulae of the original pharma- 
copoeia have been found to be defective or objectionable, their place 
has been supplied by more accurate and practicable rules, founded 
on a course of careful investigations. In this way, the economy and 
uniformity of certain processes is greatly promoted. New prepara- 
tions, which have been brought to light by the uncommon progress of 
pharmaceutic investigations, during the last dozen years, are, in va- 



Pharmacopoeia of the United States. 153 

rious instances, inserted. Such are the preparations of iodine, qui- 
nine and morphine. The convention, however, have shown a wise 
forbearance, in not crowding their book with the host of new arti- 
cles, often, we apprehend, more curious than useful, which modern 
chemistry has been enabled to extort from vegetable drugs. Re- 
trenchment has been freely exercised in lopping off many of the su- 
perfluous formulas, which a necessity for hasty compromise had 
caused to be introduced into the pages of the old pharmacopoeia ; and. 
among other articles dismissed, is the acetum opii, or black drop, a 
revived piece of antiquity, wasteful in its composition, and utterly 
uncertain in its strength; the place of which is now better supplied 
by the acetated tincture of opium, and the acetate of morphia. For 
ourselves, by the way, we lean to the opinion, that opium, to pro- 
duce its full benefit, must be opium still, and we are not sure that 
any of the artificial salts of morphia, are better than the natural me- 
conate. We have seen delirium tremens brought on under the use 
of denarcotized laudanum. If the crude drug were cumbersome from 
the bulk necessary to form a dose, as in the case of cinchona, it 
would be highly useful to reduce its active ingredient into a smaller 
compass. But this is not the case with many of the narcotics. 

Very complex medical formulas, such as abound among the old 
writers, and still encumber the pages of many of the pharmacopoeias, 
we deem to be a superfluous appendage to medical science. One of 
the greatest modern improvements, is found in the simplification of 
medical prescriptions. The art of prescribing appears to us a more 
simple affair than it has been represented by the hypercritical pe- 
dantry of Dr. Paris. We admit that adjuvants will help, and that 
corrigents will correct; nevertheless, we find that castor oil, ipecac. 
and opium, will often do their duty without either. In admitting 
the influence of chemical considerations, in the exhibition of medi- 
cines, it is important to recollect that the stomach has a chemistry of 
its own, and that the digestive organs exert a material controul over 
the force of ordinary chemical agents; separating elements which 
have strong mutual attractions, and dissolving bodies which are in- 
soluble in common menstrua. We ought by no means to consider 
medicines inert, in proportion as they are insoluble, for we have a 
proof to the contrary, in calomel. Nor are we to consider those sub- 
stances medicinally incompatible, which if mixed out of the body, 
occasion a precipitate, or a change of colour. What incompatible, 
we would ask, destroys the effect of opium, arsenic, or cantharides? 
Another consideration which has great weight with writers on 

14* 



154 Pharmacopoeia of the United States. 

chemistry and pharmacy, is the exactness and precision of the quan- 
tities employed in their preparations. This circumstance, although 
of great consequence in strictly chemical compounds, is less so in 
arbitrary mixtures; and in the administration of simpler medicines, 
its importance diminishes still further. Practical physicians know, 
that a degree of accuracy, approaching nearer than within a fifth or 
sixth part of the amount desired for producing a given effect, is sel- 
dom attainable. Apothecaries divide their pills and powders by the 
eye, and patients take liquids by drops and spoonfuls. Nay, that 
physician must possess uncommon shrewdness, who even after ap- 
portioning his dose by the most accurate weight and measure, can 
foretell with certainty, how or when, how much or how often, it is 
going to operate. The stomachs of different patients, and those of 
the same patient at different times, vary more, if possible, than the 
samples of the same drug in commerce. 

On these accounts we feel but little concern for the changes which 
the convention have thought proper to make in the character or 
strength of preparations and compositions, so long as they do not 
exceed the limits above mentioned. But in a few cases we observe 
that the strength has been altered in the proportion of two to one, or 
vice versa, and of such changes we propose to take notice. The vi- 
num antimonii, which in the old edition contained four grains to the 
fluid ounce, in this edition contains but two, and is therefore re- 
duced in strength one-half. We object to this change, because the 
stimulating character of the menstruum is incompatible with the indi- 
cations for which antimony is generally administered, and we appre- 
hend that a glass or two of Teneriffe wine would do no good to a man 
in apoplexy, or incipient fever. The wine indeed, ought to bear as 
small a proportion as possible to the operative medicine, and if the 
London college is followed in lessening the proportion of antimony, 
it should also have been followed in diluting the wine largely with 
water. The vinegar and syrup of squill are increased to twice their 
former strength, a change in itself of no consequence, when the pub- 
lic shall have learned to regulate the dose. Liniment of ammonia is 
reduced to one quarter of its former strength. Can this preparation 
ever be too strong for the purposes to which it is applied? 

In a work so generally uniform and consentaneous in its parts as 
the American Pharmacopoeia, we would willingly have dispensed with 
such names as pulvis aromaticus and pilulse cathartics composite. 
These names designate nothing which is not common to a thousand 
other combinations. 



Pharmacopoeia of the United States. 155 

A few things are omitted in this edition, which we would have 
willingly seen retained; but we are not disposed to cavil on this ac- 
count, since in that instance, as well as in the case of objectionable 
formulae, the evil may generally be remedied by extemporaneous pre- 
scription. Every man has his particular taste and judgment, and 
de gustibus non disputandum. In the wine of antimony, to which we 
have objected, the evil is remedied by extemporaneous solutions in 
water, which are far preferable to those in wine. Even though a 
pharmacopoeia should arrive at the highest and most unquestioned 
point of excellence, still physicians would suit themselves with for- 
mulas of their own adapted to particular cases. We apprehend that 
most practitioners pass their lives in ignorance of half the contents 
of pharmaceutical works. For ourselves, not being particularly given 
to hyper-practice, we should feel a strong sentiment of pity for the 
patients of that physician whose yearly rounds involved the applica- 
tion of a whole pharmacopoeia. 

To conclude, having indulged somewhat freely in our remarks on 
the national work produced by the convention at Washington, we 
proceed to make the amende honorable, by declaring our conviction^ 
that it is on the whole superior to any of the European pharmaco- 
poeias with which we are acquainted, that it is better suited to the 
wants of the American community than any work of the kind which 
has been published among us, that it has emanated from a larger de- 
legation and has undergone a more rigorous supervision than any 
similar production of the day, and that, therefore, it ought to become 
the standard of the United States. In conformity with the views 
expressed in the first part of this article, we also hope, that, to relieve 
the profession from the annoyance of incessant fluctuations, the con- 
tents of this book will be respected by all future conventions as some- 
thing solid and permanent; and that if, as the edifice grows old, it 
shall be found to need repairs, enlargement, or modern decorations., 
still that its foundations may not be wantonly assailed, and that its 
walls may stand as a landmark and a barrier against the confusion of 
fluctuating language. J. B. 



156 Physiological Medicine, 



Art. XIV. Exposition des Principes de la Nouvelle Doctrine Medi- 
cate, avec un precis des theses soutenues sur ses differentes parties. 
Par J. M. A. Goupil, Docteur en medecine de la Faculte de Paris, 
Demonstrateur a Phopital militaire de Toulouse, &c. &c. &c. 8vo. 
pp. 603, Paris, 1824. 

Exposition of the Principles of the New Medical Doctrine. By J. M. 
A. Goupil, D. M. P. &c. 

MEDICINE, one of the oldest and most important sciences to 
which the attention of man has ever been directed, is still enveloped 
in obscurity, still deficient in fixed principles, and subjected to the 
caprice of the ignorant and the prejudiced. When we reflect that 
this science has received the most devoted attention of some of the 
greatest men of almost every age, we are very naturally surprised at 
its present imperfect condition. But those who have examined the 
history of medicine, have ceased to wonder, that the greatest sum 
of genius and labour ever directed into one current, has failed to per- 
fect a science, the almost unlimited extent, and extreme intricacy of 
which, are sufficient apologies for the unsettled state of many of its 
principles. We would by no means pretend that little has been 
done in medicine. The mass of facts collected is immense; the 
theories and hypotheses which have successively arisen and fallen 
are innumerable ; and the number of well-established principles, 
though small in proportion, is still considerable. 

Of all the systems of medicine yet proposed, that of Broussais is 
the only one strictly conformable to the Baconian principles, and 
therefore erected on an immoveable foundation. In reviewing the 
work before us, we shall adopt the analytical method, so success- 
fully employed by some able reviewers, in the preceding numbers of 
this journal. In so doing, we shall, while we avoid all useless specu- 
lation and vain embellishment, condense, into the present paper, a 
greater number of the precepts of the illustrious reformer, and give 
a more connected view of his system, than could otherwise be done. 
All that we ask of our readers is, to examine the subject fully 
and fairly, even experimentally; this done, we leave the rest to 
reason. 

The medical doctrines of Broussais are founded on observations 
made at the bed-side, and in the dissecting-room. They are in di- 
rect opposition to the empirical character of English medicine, over 
which they must finally triumph. The correctness of these princi- 



Physiological Medicine. 1.57 

pies depends on the accuracy of the observations from which they 
have been deduced, and the logical manner in which the deductions 
have been made; and their practical efficacy is the source of their 
present popularity and future stability. 

The work of M. Goupil consists of a condensed view of the theses 
of several writers, very freely interspersed with his own observa- 
tions. The first part of the volume embraces the subject of irrita- 
tion in general. M. Goupil observes, that before the origin of the 
physiological doctrine, inflammation was the only form of irritation 
which had attracted attention; and that even that phenomenon was 
recognised in a few tissues only. He very justly ascribes to M. 
Broussais, the merit of accurately determining the symptoms of the 
various inflammations, and especially of those of a chronic kind. 
The thesis first quoted, is that of M. Vialle, on irritation. This 
author states, that physiologists admit the existence of two funda- 
mental properties; viz. sensibility and motility; to which they refer 
all vital phenomena. M. Broussais, (says Goupil,) denies the practi- 
cability of a distinction between sensibility and contractility; be- 
cause the latter is, according to him, the only evidence of the for- 
mer; and he makes contractility the principle, by the agency of 
which, all the vital phenomena are manifested. Yet Broussais be- 
lieves, that the composition and decomposition of the tissues, are not 
ihe effects of the vital properties; but attributes them to a preexist- 
ing " force vitale," and refers assimilation to the " chimie vivante," 
which, under the direction of the " force vitale," performs compo- 
sition and decomposition. This js very abstruse; but we must al- 
low, we think, a something existing before organization, and pro- 
ducing it; and also, that vital composition and decomposition are 
the results of chemical affinity, modified by a power which is very 
well expressed by the term "force vitale." M. Vialle observes, 
that the nerves and blood-vessels penetrate all the organs, and that 
by their condition we recognise health and disease. Brown is cor- 
rect in saying that life is preserved by stimuli. Some tissues pos- 
sess more excitability than others: thus, the mucous membranes 
possess it in a greater degree than the skin, and this last in a greater 
degree than the cellular tissue; and as these tissues are not equally 
subjected to the influence of stimulants, it results, that one or more 
tissues may be irritated, or inflamed, while the rest of the system is 
in a state of debility. Ignorance of this fact was Brown's greatest 
error. Peculiarities of temperament depend on the excessive de- 
velopment of some tissue. Hence proceed predispositions to par- 



158 Physiological Medicine. 

ticular diseases. The action of stimulants produces that exaltation 
of the vital properties which constitutes irritation; and the abstrac- 
tion of the usual stimuli generally produces the diminution of vital 
manifestation, which characterizes debility. 

Irritation of an organ, and its consequent congestion, are effected 
by, 1st, the direct application of a stimulant. 2d. An impression 
sympathetically received from another organ already irritated. 3d. 
The absence of the usual stimuli. We have inflammation of the 
stomach from hunger. 4th. The diminution of action in some other 
organ. Exposure to cold, by checking the action of the skin, in- 
creases that of the lungs: hence, inflammation of the mucous surface, 
and even of the substance of the lungs. Living in damp rooms, with 
bad food and cold air, produces inflammation of the lymphatics, by 
diminishing the vitality of the heart and arteries. We therefore 
never have general excitement nor general debility; since the agents 
which excite one system of organs debilitate another, and vice versa. 
In fact, a very small blood-letting will sometimes increase a pulmo- 
nary inflammation, by debilitating the general system. 

Irritation commences in the nerves, and is thence propagated to 
other parts. Where the irritation is confined to nerves, we have the 
diseases termed neuroses. But the irritation soon extends to the 
capillary vessels; the vessels become turgid, filled with red blood, 
hot, and painful. This is inflammation, a state of which irritation 
is the element. Under the influence of this irritation, the capillaries 
sometimes emit blood. This constitutes hsemorrhagic irritation, as 
seen in haemoptysis, and in vomiting of blood from the irritation of 
an emetic. If the irritation be seated in the vessels which convey 
colourless fluids only, we have sub-inflammation, marked by swelling 
and accumulation of white fluids, without the presence of pain, heat, 
or redness; thence result scirrhus, tubercle, and other chronic de- 
generations. 

The next subject is the local phenomena of irritations; and on this 
subject we quote the thesis of M. Duponchel. In internal inflam- 
mations, the situation of the organ often prevents us from perceiv- 
ing the local lesion, and we must determine the nature of the case 
from the sympathetic derangements of other organs. In moderate 
gastritis there is often no pain of the stomach, while the head and 
limbs suffer considerably. Pain in the right shoulder is a common 
symptom of obscure hepatitis. Pain is therefore often absent in in- 
flammation. Redness is always present during life. After death it 
is usually present, but sometimes is wanting. Acute peritonitis and 



^Physiological Medicine". ] 59 

troup are examples; both sometimes failing to present a trace of red- 
ness. M. Begin has found the mucous digestive membrane white? 
after rapid death from corrosive poisons. 

M. Vialle observes, that inflammations do not tend to subside on 
particular days. He gives the usual description of the course and 
effects of inflammation. M. Goupil then considers chronic inflam- 
mation, by which is meant, not a long-continued disease, but one of 
slight intensity and slow progress. Acute inflammation may subside 
into a chronic state, the characters and treatment of which differ from 
the former in activity only. The occasional effects of chronic in- 
flammation seated in very vascular tissues, are hepatization, (the red 
induration of M. Broussais,) in the lungs, callosity of the skin and 
cellular tissue, and thickening of the mucous membranes. The red 
induration sometimes changes into white induration* 

Sub-inflammations are rarely primitive, being usually excited by a 
preexisting red inflammation. Thus, gastro-enteritis sometimes ex- 
cites irritation and swelling of the mesenteric ganglions, and this 
complication of gastro-enteritis with lymphatic sub-inflammation con- 
stitutes tabes mesenterica. Tubercles are developed in the lungs by 
inflammation of the bronchial mucous membrane, or even of the pa- 
renchyma or pleura. These sub-inflammations remain long after the 
subsidence of the original red inflammation. Chronic irritation in 
the white tissues indurates them, and finally softens them by com- 
plete disorganization. This, in the lungs, produces phthisis, and a 
sympathetic gastro-enteritis supervening, we have hectic fever. Sub- 
inflammation is not confined to the lymphatic ganglions, but exists in 
the white vessels of any part. Pathologists have erred in attributing 
diseases of the lymphatics to debility of that system. The apparent 
debility depends on the predominance of the lymphatic over the san- 
guineous system. The lymphatic diseases are irritations of that 
system, the undue development of which predisposes to disease. 
Scrofula is an example. When both the lymphatic and sanguineous 
systems are active, scrofulous inflammation progresses more rapidly. 
Lymphatic diseases have been supposed to be atonic, because they 
may proceed from debilitating causes, and are sometimes cured by 
tonics. But these causes, by debilitating the circulatory apparatus, 
have directed the vital energies upon the lymphatic system, which, 
under these circumstances, becomes more subject to irritations. To- 
nics sometimes cure this irritation by exciting the circulation, and 
thus effecting a revulsion. 

JVL Broussais considers sub-inflammation as the origin of fatty ? 



160 Physiological Medicine. 

steatomatous, and other analogous tumours. To the same cause 
must be referred the softening of bones, and the development of the 
chronic exanthemata, as tinea, &c* The most remarkable form of 
sub-inflammation is scirrhus. MM. Lemercier, Chanriont, and 
Marechal, have written theses on this subject. They have ascer- 
tained that all the causes of scirrhus, and its more advanced form of 
cancer, are easily traced to irritation. Such are falls, blows, violent 
pressure, or friction, the long-continued application of stimulants to 
points affected with common inflammations, by which these are ren- 
dered malignant. In this case the irritation is seated in the white 
vessels, constituting scirrhus; and when extended to the sanguineous 
vessels it brings on carcinomatous ulceration. Certain constitutions 
are predisposed to cancer as to other diseases. Cancer is a local 
disease, and does not depend, as was once imagined, on a virus in 
the blood. Being a disease of irritation, it should be treated on the 
same principles as other irritations. M. Marechal gives a minute 
detail of thirteen cases of genuine cancer, cured by local bleeding 
by means of leeches, a very low diet being also used. These cases 
deserve the particular consideration of the practitioner. 

After giving, in a full and interesting dissertation, the facts and 
arguments from which the above observations are taken, our author 
proceeds to the consideration of hemorrhages and neuroses. It has 
been observed that one effect of an irritation seated in the capillary 
vessels, is a disposition to pour out blood in considerable quantity. 
Hence, an important class of diseases, the successful treatment of 
which is peculiarly dependant on the correctness of the practitioner's 
theory. Physiological medicine has thrown much light on the theory 
of haemorrhages, and has consequently, much improved the treatment 
of these diseases. Haemorrhage was long supposed to proceed from 
a rupture of some large vessel of the diseased organ. Morgagni, 
and after him Bichat, ascertained that no rupture occurs, and that 
the blood is exhaled from the capillaries. The old humoral patholo- 
gists, visionary on all subjects, viewed it as the effect of a vitiated 
condition of the blood, which, becoming too fluid, escaped from the 
vessels. Brown unfortunately imagined all haemorrhages to proceed 
from debility. Pinel, seeing symptoms of local irritation precede 
and accompany haemorrhages, but sometimes overlooking these symp- 
toms, supposed that it might proceed from either excess or deficiency 
of vital action. The latter opinion is now prevalent in England and 
in this country. It is, however, much opposed by the author of phy- 
siological medicine and his school in France; and haemorrhage is. 



Physiological Medicine. 161 

supposed by them to proceed in all instances from irritation. On 
examining a part to which a sedative has been applied, or which has 
been accidentally debilitated, we do not find an unusual quantity of 
blood in it, but on the contrary it is pale, cool, less sensible than 
usual, and evidently in an inactive condition. Apply an irritant, 
and the part reddens, becomes hot and tender, and inflammation or 
haemorrhage comes on. Debility, then, excludes blood from a tissue, 
while irritation invites it. However great then may be the debility 
of the muscular and cutaneous systems, there is always local irrita- 
tion in haemorrhage. Very intense irritations may arise in the most 
debilitated habits, and in such we often see blood discharged from the 
intestines in dysentery, from the lungs in catarrh, and from the kid- 
neys in inflammation of those organs. Haemorrhages too are best 
cured by powerful debilitants, as is seen daily. Astringents, it is 
true, are often efficacious, but they are also useful in inflammations 
which are moderate. Scorbutic and petechial haemorrhages are offered 
as examples of atonic haemorrhage. The same error exists here also. 
They are symptomatic of visceral irritation, and are best removed 
by such treatment as is calculated to relieve that state. 

Broussais has greatly limited the number of the neuroses; since 
the term strictly signifies an increase or decrease of action in the 
nerves alone, and since nervous disease seldom, if ever, exists lorn'; 
without involving the blood-vessels. 

We come now to the subject of the sympathetic phenomena of ir- 
ritations; to which subject M. Goupil devotes the third chapter of 
his work. Much of this chapter is derived from the thesis of M. 
Moncamp, on sympathies. We will not detain the reader with the 
first part of the chapter, in which our author offers some objections 
to some of the views of M. Moncamp and others, on sympathy. The 
most important deductions from this part of the chapter are, that the 
nerves are the true media of sympathy, and that, although disease 
developes sympathies between organs, which do not appear in health 
to be associated, yet it is probable that the sympathies do exist in 
health, though less strongly than in a pathological condition. The 
sympathies are modified by many circumstances. Those organs which 
are important, as the stomach, heart and brain, throw the whole sys- 
tem into commotion, when diseased; while ligaments, the cellular 
tissue, and others, produce much less disorder. The intensity of the 
irritation will obviously have great influence. The constitution of 
the individual also, has a great effect; the sympathies between organs 
being far less intimate in robust and lymphatic constitutions than in 

No. XV.— May, 1831. 15 



162 Physiological Medicine. 

those of a delicate and irritable habit. In such cases, diseases will 
produce different effects, and demand different treatment. The age, 
sex, and climate, as well as the cause which produces the irritation, 
are so many modifiers of sympathetic effects. Those organs, the 
sympathies of which are most extensive, receive the greatest number 
of impressions from other organs. It is from this fact that the gastro- 
intestinal mucous membrane becomes implicated in all extensive ir- 
ritations. The irritations which arise sympathetically, do not differ 
from those which are idiopathic; meningitis produced by gastroen- 
teritis, and meningitis from a blow, not differing. The sympathetic 
irritation may rise above the original one, and form the prominent 
feature of the disease. A sympathetic irritation may be of a different 
kind from that which produced it. Thus, hsemorrhagic irritation 
of one organ may proceed from inflammation of another; and neural- 
gia may produce sympathetic gastritis. An irritation may give rise 
to another of the same kind; as in cancer, or tubercle; and this, ac- 
cording to M. Broussais, constitutes diathesis. It is important that 
the practitioner should be intimate with the sympathies, in order to 
avoid mistaking sympathetic for idiopathic diseases. In speaking of 
sympathy, as connected with therapeutics, M. Moncamp observes, 
that our remedies should be directed to the primary disease. Thus, 
we sometimes see an erysipelas suppressed in one place, reappear in 
another; but if we remove the gastric irritation, of which the former 
is the effect, we effectually cure the cutaneous disease. M. Brous- 
sais frequently cures inflammation of the joints, by applying leeches 
to the epigastrium. Leeches to the joint itself would have failed, 
by leaving gastritis; and the disease would have been reproduced. 
A local inflammation produces fever by irritating the stomach, heart, 
and brain; and as the sympathies of the stomach are more extensive 
and intimate than those of the heart, we cannot have fever, without 
gastritis, or at least gastric irritation. In common fevers the irrita- 
tion of the heart and brain does not rise to inflammation; but when 
the gastro-enteritis is very violent, the brain and heart are often in- 
flamed. 

The next subject is the application of the phenomena of sympathy 
to the explanation of revulsions. The more intensely an organ is ex- 
cited the greater is its susceptibility of new excitement. If an organ 
receives sympathetically an irritation less than that of the organ pri- 
marily irritated, it only affords symptoms of the original disease. 
When the sympathetic irritation becomes intense, the original irrita- 
tion often subsides. If, under these circumstances, the sympathetic 
irritation continues, and forms a new disease, we term the accident 



Physiological Medicine. 163 

metastasis; but if the secondary irritation also subsides, we term 
it a crisis. M. Goupil observes, that metastases may also be called 
crises. We may imitate nature by producing revulsions, or artificial 
crises. M. Goupil combats the hypothesis of those who suppose cri- 
tical evacuations to be efforts of nature, to throw off unwholesome 
fluids. The diminution of the fever of small-pox, by the appearance 
of an eruption, is referred by the humoralists, to the expulsion of a 
virus. Why, says our author, is not the cure of pleurisy by perspi- 
ration explained in the same manner. Such absurdities deserve no 
further notice, our author having opposed them with unmerited pa- 
tience. A cephalitis may result from the suppression of gout; and 
the inflammation of the brain is supposed by the ontologists to pos- 
sess what they imagine to be the specific nature of gout. M. Brous- 
sais observes, that it were not more absurd to speak of mania in the 
toe, than of gout in the brain; gout being essentially an articular in- 
flammation. An organ affected with chronic inflammation very 
easily receives irritation from another organ, and may produce a re- 
vulsion of the irritation seated in the latter point. Hence, if 
amenorrhcea and chronic gastritis coexist, the first indication is to 
cure the latter, in order that the vital actions may not be diverted 
from the uterus. A sympathetic irritation may fail to cure the pri- 
mary disease, by being too slight, or too strong. Thus, a slight 
erysipelas will fail to remove a gastro-enteritis; if stronger, it will 
relieve completely; or, if very intense, it will exasperate the gastric 
irritation. This last accident is termed a false crisis. 

A gradual transfer of the vital energies from one entire system to 
another, is common. Thus, in sanguine temperaments, the vital ma- 
nifestations are constantly concentrating themselves in the circula- 
tory apparatus, and the most powerful sedatives are demanded for the 
controlment of the inflammatory diseases thus developed. The stu- 
dent, leading a sedentary life, robbed of the stimulus of exercise, 
and exhausted by nocturnal labours, to which he is tempted by his 
literary taste, finds his circulation languid, while the nervous and 
lymphatic systems begins to predominate, and he becomes the vic- 
tim of nervous diseases, or is attacked with scrofulous irritation. 
The excessive development of the lymphatic system, is often associ- 
ated with such a want of activity in the circulatory apparatus, as to 
induce the belief that scrofula is a disease of debility. This is in- 
correct; the circulation alone languishing while there is irritation of 
the lymphatics. Those measures which restore the activity of the 
circulation, tend to remove the lymphatic irritation. If we apply 



164 Physiological Medicine. 

leeches near inflamed lymphatics, at the same time that we advise a 
dry, airy residence, a nutritious diet, and exercise, it is only for the 
purpose of debilitating the lymphatics, while we operate a revulsion 
upon the circulatory organs. 

The fourth chapter of the work under consideration, is devoted to 
the examination of intermittent irritations, and most of the observa- 
tions are taken from the thesis of M. Mongellaz. It will be recollect- 
ed by physiologists that the functions of the organs are intermittent. 
The stomach does not always digest, the muscles are not always con- 
tracting, nor does the brain produce uninterrupted thought. The 
same occurs in disease. The number of periodical coryzas, phleg- 
mons, eruptive diseases, haemorrhages, neuralgias, and other irrita- 
tions is very great. M. Broussais first demonstrated the pathologi- 
cal character of these irritations. Inflammation, in the form of fever, 
is the most common form of intermittent irritation. Many kinds of 
intermittent fever were formerly enumerated. The fever was hepa- 
tic, pleuritic, or dysenteric, according to the intensity of the symp- 
toms shown by particular organs. When no organ offered very pro- 
minent symptoms, the disease was simple intermittent fever. When 
there existed an irritation without fever, it was called a masked fe- 
ver. Such was the delusion of the ontologists; dividing a disease into 
numerous imaginary beings, and even creating fever where no febrile 
symptom existed. They have even gone so far as to deny, that in- 
termittent fever depends on local inflammation. But what grounds 
have they for their opinion? None ; they merely refuse to grant the 
possibility of an intermittent inflammation. The proofs of our as- 
sertion are irresistible. The symptoms of intermittent fever, are 
those of other inflammations. Its causes are the same as those of 
other inflammations. It sometimes produces external inflammations, 
by the revulsive agency of which it is cured. This is merely a 
transfer of the gastro-intestinal inflammation, as happens in other 
inflammations. The evidence of post mortem examinations, is an 
irresistible proof of the inflammatory nature of fever. The ontolo- 
gists object, that intermittent fever is cured by tonics. The objec- 
tion is idle; as the tonics are administered in the intermission, when 
there is no inflammation, and usually increase the disease, if used 
during the fever. Even when this last does not happen, we are not 
surprised, since we see ophthalmia, diarrhoea, and gonorrhoea, often 
cured by tonics. The intermittent nature of the healthy functions, 
tends to give a similar character to the same functions in a morbid 
state. The causes of irritations are often intermittent. Intermit- 



Physiological Medicine. 165 

tent fever is most common in the spring and autumn; at which times 
the system is subjected to alternations of heat and cold; the days 
being warm and the nights chilly. Malaria, the most common 
cause of intermittent fever, exerts an intermittent influence. During 
the day the atmospheric poison is rarefied by the sun, and dispersed 
in the air, but at night it is precipitated in union with aqueous va- 
pour, and the lower portions of the atmosphere are rendered noxious. 
Habit exerts an almost unlimited influence, both in health and dis- 
ease, and an intermittent fever is sometimes kept up by it alone. 
These opinions on the intermittent character of the causes are due 
to M. Roche. Our author observes that some causes of intermittent 
fever do not generally appear to be intermittent. Even here, the 
intermittent nature of the healthy function affords a plausible expla- 
nation. 

The fifth chapter of the work before us, is devoted to the consi- 
deration of the treatment of irritations; and here, particularly, we 
see the beautiful simplicity, and the practical utility of physiological 
medicine. Irritations are cured by debilitants, by revulsive irri- 
tants, and by stimulants applied to the irritated organ itself. Each 
of these plans deserve separate consideration. Debilitants are those 
means which abstract the principles of nutrition, or directly dimin- 
ish the vital actions. Such are, abstinence from food, blood-letting, 
mucilaginous fluids, cold, and perfect repose. The thesis of M. 
Flahant furnishes valuable observations on general bleeding, the 
most powerful of the debilitants. When a vein is opened, the blood 
flows more rapidly into it, and is thus removed from the general 
mass of fluids, which becomes much less. The consequence is, that 
the brain, heart, and other organs, receiving less stimulation than 
usual, the vital actions of the irritated organ, as well as of the sys- 
tem in general, are diminished, and the irritation often removed. 
The effects of local depletion differ from those of general bleeding. 
The application of cups or leeches, produces, besides the loss ot 
blood, a revulsive irritation, combined with congestion. If the flow 
of blood be free, the local irritation is in a great measure counter- 
acted; while, if the depletion be slight, the irritation predominates. 
Hence, if we desire a moderate depletion with considerable revulsive 
irritation, we may apply cups; while, if we propose a more free de- 
pletion with less irritation, leeches are proper. Local depletion, 
when moderate, has little effect on the general system, emptying the 
capillaries and acting immediately on the surrounding parts. We 
must refer the effects of local bleeding to sympathy, since we cannot 
otherwise explain the rapid cure of gastritis or catarrh by the applica- 

15* 



166 Physiological Medicine. 

tion of leeches over the epigastrium or sternum; no capillary commu- 
nication existing between the viscera and the skin. In inflamma- 
tions of the membranes, general depletion is much less efficacious than 
local bleeding. In inflammations of the mucous membranes especi- 
ally, we seldom completely succeed by general depletion; on the con- 
trary, we often diminish the mass of blood, and exhaust the patient 
without at all affecting the local irritation and congestion, which, 
being seated in the capillaries, is not easily affected by depleting the 
large vessels. In these cases, therefore, we must apply leeches to 
the skin nearest the inflamed organ. When, however, the inflamed 
organ is very vascular, as are the parenchymatous structures, and the 
circulation is violent, the benefit of local bleeding will be temporary, 
unless preceded by general depletion. This fact is important in acute 
hepatitis and pneumonia. In chronic inflammations local bleeding 
alone is proper, and is our most powerful agent. In external inflam- 
mations, local bleeding is very efficacious, and should be practised 
as near the diseased part as possible, unless the irritation be great; 
in which case the leeches or cups should be placed at a short distance 
from the inflamed point. When the strength of the patient is suffi- 
cient, we may repeat our local depletion as often as it is required; 
but, in the state of extreme prostration occurring in the advanced 
stages of some inflammations, as in typhus fever, even local bleed- 
ing may prove fatal. Here we resort to other sedatives and to re- 
vulsives. We must not mistake for debility that false weakness and 
oppressed pulse so common in the commencement of inflammations: 
bleeding here developes the pulse and strengthens the patient. When 
local irritation is great, our local depletion must be free; otherwise 
cups or leeches may be injurious. To aid the effects of general and 
local bleeding, we must restrict the patient to the most rigorous diet, 
apply cold, and if the viscera be inflamed, use mucilaginous drinks 
containing a little citric acid. Too free a diet counteracts our de- 
pletion. Nervous irritation demands the same treatment; the dis- 
eases called nervous being generally chronic inflammations. For 
these precepts on the use of local depletion we are indebted to our 
author and to M. Labauche, with whom we fully concur. 

Our attention is next called to the application of revulsives. Re- 
vulsion is the diminution of one irritation by exciting another in a 
different part. The following rules are taken from the thesis of our 
author. We must never attempt a revulsion of an irritation which 
excites fever, as it is too powerful to be removed, and will be exas- 
perated by the new irritation. To this we have seen a few exceptions 
besides those given below. Never then apply a blister to the chest 



Physiological Medicine. 167 

in a pleurisy or peripneumonia so violent as to excite fever; such 
conduct being empirical and hazardous. Reduce the irritation by de- 
bilitants, until it cease to excite fever, and then apply revulsives to 
prevent it from becoming chronic. To the above rules there are some 
exceptions. In very violent inflammations of the brain and its me- 
ninges we must apply cold and leeches to the head, while the skin of 
the feet and legs is irritated by stimulants. In violent gastro-ente- 
rites, (ataxic and adynamic fevers,) when the important organs are 
congested, and there is too much prostration to admit of even local 
bleeding, we resort to revulsive irritants, applied to the skin. Re- 
vulsion is practicable in these cases, on account of the diminution of 
sensibility. Chronic inflammations are successfully treated by re- 
vulsives; but if they be great enough to excite sympathies in other 
organs, they must first be reduced by debilitants. Thus, in chronic 
pleurisy, we must not apply vesicatories to the chest, until a low 
diet, and local bleeding, have controlled the action of the heart, and 
the heat of the skin. When an inflammation is transferred from 
one organ to another, we restore it to the first organ, by applying to 
it irritants, at the same time that we apply local bleeding, and other 
debilitants, to the second organ. If, for instance, an ulcer dries up 
at the commencement of a fever, we cannot re-establish the ulcer, 
without, at the same time, applying leeches and cold to the epigas- 
trium. What has been said of revulsives in acute irritations, may 
be affirmed of the same means, in moderate irritations having great 
extent. What advantage can we expect from blisters, in a moderate 
inflammation involving the greater part of the peritoneum ? Revul- 
sives are almost always injurious to very irritable patients, and must 
be removed as soon as their bad effects are perceived. Where, from 
idiosyncracy, any organ is unusually irritable, we sometimes irritate 
it, by attempting to produce a revulsion from another organ, or by 
accidentally exciting the latter. Richerand has seen a full. meal 
produce empyema, by transferring the irritation of an ulcer to the 
pleura. It is dangerous to attempt a revulsion from one organ to 
another, which is very sensible, from the lungs to the stomach for in- 
stance. The artificial irritation should always be great enough to 
effect a revulsion, without going so far as to rekindle the original 
disease. A cutaneous eruption, therefore, or a phlegmon, appearing 
in a fever, must not be interrupted, unless it becomes too violent. 
In attempting a revulsion from any organ, apply the revulsive to a 
part, the excitement of which debilitates the former. A revulsion is 
thus effected from the lungs to the skin. Avoid the application of 
revulsives to a point, the stimulations of which, are reflected to the 



1 68 Physiological Medicine. 

diseased organ. We avoid, therefore, the use of blisters in gastro- 
enteritis. One exception to this has been mentioned; and another is, 
that we may irritate the skin, when the gastro-enteritis is the result 
of a suppressed cutaneous eruption; using internal debilitants at the 
same time. Hemorrhagic irritation of the digestive mucous mem- 
brane, may also be treated by vesicatories to the abdomen; the 
haemorrhage assisting the revulsive. Here we cannot agree with the 
author unless the fever be but slight. When a chronic inflammation 
is seated in a very vascular organ, if our revulsives do not increase 
the disease, we must not relinquish them too soon, but persist for a 
longer time than is usual; by which means we will generally succeed. 
Revulsives are successfully opposed to nervous irritations and 
haemorrhages, as well as to inflammations. An issue to the chest 
will often prevent consumption in persons disposed to that disease. 

We come now to the consideration of the various irritants, the ap- 
plication of which, to the treatment of irritations, has been much 
restricted, by rational or physiological medicine. Irritants have been 
much abused by ontologists. Emetics are prescribed for fevers, ex- 
pectorants for catarrh, and emmenagogues for amenorrhea. Fortu- 
nately for patients, the revulsive agency of these medicines very often 
counteracts their local effects. Tonics and stimulants should never 
be applied to the treatment of inflammations, especially when seated 
in the stomach and intestines. They renew the irritation, and give it a 
chronic type. Hence, the dyspepsias, and the scirrhus alterations of 
the stomach and intestines.* Hence, the numerous cases of phthisis, 
brought on by expectorant balsams, used in the treatment of catarrh. 
The application of astringents, to the treatment of irritations of the 
kidneys, bladder, and urethra, as well as to the vagina, has given rise 
to innumerable cases of the most tormenting and incurable diseases; 
among which, is cancer of the os uteri. The irritants called antiscor- 
butics, should be banished from the treatment of scurvy; that disease 
consisting in a gastro-intestinal irritation, by which sanguification and 
nutrition are vitiated. Most of the diseases supposed to be nervous, 
and especially those of the stomach, are chronic inflammations; and 
in these, the antispasmodics are sometimes successful, but often inju- 
rious. Some of these diseases are, however, really nervous; and are 
often relieved by antispasmodics, provided the stomach be healthy. 
M. Goupil shows the fatal errors of the Italian contra-stimulant doc- 
trine. He observes, that almost all their pretended contra-stimulants, 
are capable of exciting inflammation of the stomach. Of this, emetic 

* In admitting" this rule, we would make allowance for extreme debility in 
some chronic cases, as in phthisis. 



Physiologica I Medicine. 169 

tartar is an example. He observes, also, that these medicines, like 
other irritants, cure inflammation, bj revulsive secretions; and not, 
as the Rasorians imagine, by a debilitating action. Narcotics, and 
especially opium, are active stimulants, and produce much cerebral 
congestion. They must be used with much caution in diseases of 
infants and old persons, because there is a great predisposition in 
such persons to cerebral irritation. They must never be opposed to 
sleeplessness caused by a local inflammation. They may, however, 
be used in purely nervous agrypnia; a rare disease. On account of 
their irritating properties, they must be avoided in all inflammations, 
both acute and chronic; their revulsive action often failing to occur. 
In chronic colitis, however, says M. Goupil, when there is neither 
pain nor fever, no tenesmus, and the evacuations moderate, and not 
bloody, opium is very useful. Besides this exception made by Gou- 
pil, M. Broussais observes, in his Histoire des Phlegmasies Chro- 
niques, "Popium nous reste encore: c'est toujours la meilleure res- 
source contre les irritations de la poitrine qui refusent de ceder aux 
antiphlogistiques, et qui sont exasperees par les irritans revulsifs." 
M. Goupil observes, that there are few diseases, in which the empi- 
rical use of emetics has not been common and injurious. Emetics 
are dangerous in plethoric habits, as they sometimes excite apoplexy. 
For the same reason, they must be cautiously used in very young, or 
old persons. Nervous irritability forbids their employment, on ac- 
count of the risk of convulsions. Hepatic diseases should not be 
treated with emetics; since these medicines strongly excite the liver, 
and often increase irritation. In bilious fever, the liver is always 
much irritated, and demands sedatives. Emetics often cure gastric 
and hepatic diseases, by the revulsive evacuations which they excite; 
but they often fail to produce revulsion, and here they exasperate 
the disease; such cases occur daily. Emetics, given during the 
menstrual period, may produce amenorrhea or menorrhagia; and 
during gestation, they may cause abortion. During the flow of the 
lochia, they are very dangerous, on account of the extreme irritability 
of the abdominal viscera at this period. In pleuritis, peritonitis, and 
in fact, in all inflammations, they are dangerous;* especially if the 
irritation be sufficiently intense to excite gastric sympathy. For the 
same reason, they should be banished from the treatment of hemor- 
rhagic irritations. In apoplexy, their danger is so great, that it 
were superfluous to say more, than that all physiological physicians 
avoid them. We are disposed to except cases evidently resulting 

* This opinion seems to us to be carried too far. 



170 Physiological Medicine. 

from food recently taken. In palpitations of the heart, and in the 
pretended neuroses of the stomach, they are manifestly hazardous. 
Like emetics, purgatives have been very fatally employed by the hu- 
moralists. They should be used as seldom as possible during gesta- 
tion, as they sometimes produce abortion; especially in women pre- 
disposed to this accident. During the lochial flow, they may produce 
metastasis to the mucous membrane. They are improper during 
lactation, as they communicate purgative qualities to the milk, and 
may even stop its flow, by metastasis to the mucous membrane. 
Hippocrates very justly forbids them in acute diseases. In simple 
gastro-enteritis, they are, of course, improper. In eruptive fevers, 
also, they tend to suppress the cutaneous eruption, by concentrating 
the irritation upon the mucous membrane. They are generally inju- 
rious in acute inflammations of the kidneys, bladder, and urethra. 
In peritonitis, they are very dangerous, from the irritation which 
they excite in the mucous membrane and peritoneum. In the chro- 
nic form alone of this disease, are even laxatives admissible. In 
moderate hepatitis, they usually produce a temporary relief, by the 
revulsion effected upon the intestines; but the relief is momentary, 
and the permanent effect highly injurious. In rheumatism and 
gout they are improper; because they cannot act on the local irrita- 
tion, and because they increase the gastric inflammation of which the 
articular disease is very often the effect. In hsemorrhagic irritations 
they are improper, as well as in nervous diseases and organic de- 
generations; from the general principle, that they tend to increase 
the irritation already existing. For these important cautions, with 
respect to the application of irritants to the treatment of irritations, 
we are indebted to M. Goupil and M. Vallee. Our author next 
presents a very interesting analysis of the thesis of M. Gerard, on 
digitalis. M. Gerard ascertained, by experiments made on himself, 
that the alcoholic extract is the most active preparation of this vege- 
table. Also, that minute doses taken into the stomach, diminish 
nervous sensibility, and muscular vigour, and reduce the frequency 
of the heart's pulsations. That if repeatedly used, it inflames the 
stomach, and excites the action of the heart. That it is not a diu- 
retic. That it should not be used in any case, when the stomach is 
diseased; but that it is very valuable in inflammations, when applied 
by friction. All these principles would be fully established, did our 
limits permit; its diuretic properties are, however, still asserted. 
The last section of the present chapter is occupied by a very excel- 
lent dissertation on convalescence; partly taken from the theses of 
MM. Quemont and Rennes. We regret that our limits prevent a 



Physiologica I Medicine. 171 

full analysis of this section. The most important practical conclu- 
sions are, that we should never dismiss our patient during convales- 
cence, since a chronic irritation is often mistaken for that state. 
That he should avoid all the causes which may produce the disease 
from which he is recovering. That he should never use a free diet, 
for the purpose of restoring strength; since, from the almost invari- 
able tendency to relapse, that accident will be very apt to occur: 
his diet should be moderately nutritious, without being at all irrita- 
ting. The whole tribe of tonics, emetics, and purgatives, should be 
shunned during convalescence; since they daily produce relapses, by 
irritating the convalescent organs, still very irritable, and perpetuate 
the diseases in those chronic forms, more to be dreaded than the 
acute inflammations. 

We have attempted to give as full an exposition as circumstances 
would allow of the leading principles of the only philosophical sys- 
tem of medicine ever offered to the world. To the medical practi- 
tioner we recommend the application of these principles to the treat- 
ment of diseases. If strictly and judiciously pursued, they will 
never fail him in any case not beyond the reach of art. We proceed, 
without further comment, to the next part of the work before us. 

The second part of our author's volume is devoted to the consi- 
deration of gastro-enteritis, or inflammation of the mucous membrane 
of the stomach and intestines. We pass over several pages, in which 
is contained a very interesting exposition of the numerous and im- 
portant discoveries made by M. Broussais. It will suffice to observe, 
that until he devoted himself to the examination of the subject, little 
was known of the characters of gastro-enteritis and of chronic in- 
flammation in general, and that the treatment of many diseases was 
consequently empirical. M. Goupil gives an analysis of the theses 
of MM. Moncamp and Foucault, on the sympathies of the gastro- 
intestinal mucous membrane. The sympathy between the stomach 
and brain is very intimate. A moderate stimulation of the stomach 
produces a lively flow of ideas, as after taking moderate quantities 
of wine, while indigestion is often accompanied with head-ache and 
other symptoms of cerebral disorder. Poisons taken into the stomach 
produce head-ache, vertigo and delirium. The connection of the eye 
with the stomach is known by the gastric origin of ophthalmia and 
amaurosis, both being often cured by means calculated to remove 
gastric irritation. Worms in the intestines produce dilatation of the 
pupil. Rega gives the case of a person, in whom any irritation of 
the tympanum caused vomiting. This is only an uncommon degree 
of an universal sympathy. Worms in the intestines produce itching 



172 Physiological Medicine. 

of the nose, and a disgusting odour causes vomiting. The sympathies 
of the skin with the stomach are very numerous. Soon after eating, 
the skin contracts and becomes cooler, but in a short time it is warmer 
than before eating. All the eruptive fevers are cutaneous inflamma- 
tions caused by gastro-enteritis, and the chronic cutaneous inflam- 
mations are usually kept up by gastric irritation. The locomotive 
apparatus is closely associated with the stomach, as is evinced by the 
strength conferred by tonics, and by the extreme weakness occurring 
in all intense gastric irritations. Inflammation of the joints, con- 
stituting gout and rheumatism, is often caused by gastritis, and cured 
by the application of leeches to the epigastrium. The pulsation of 
the heart is influenced by almost every impression made upon the 
stomach. The salivary glands, liver, kidneys, and lungs, sympathize 
with the stomach; gastritis deranging the secretions of the glands, 
and sometimes exciting what has been called a gastric cough. The 
genital organs are stimulated by a moderate excitement of the stomach, 
but acute gastritis produces an opposite effect. Pregnancy is an- 
nounced by nausea, and metritis excites vomiting. The several parts 
of the digestive mucous membrane are intimately associated. Gastric 
irritation renders the tongue red or foul, and titillation of the uvula 
produces vomiting. The compression of the intestines, as in hernia, 
excites violent vomiting. We thus see that no organ can be consi- 
derably diseased without deranging the gastric functions. 

The best of the theses offered on the etiology of gastro-enteritis, 
is that of M. Chauvin. He divides the causes into those acting 
immediately on the stomach, those which make their first impression 
on some other organ, and those which act both mediately and imme- 
diately. Among the former he classes all the highly-seasoned and 
stimulating articles of food, putrid fish, alcoholic and other stimu- 
lating liquids. Also tonics too freely used for the purpose of assist- 
ing digestion. Emetics, used frequently, or in that state of the 
stomach in which the tongue is foul and the secretions of the mouth 
bitter. Purgatives, often used, or used in large doses, especially in 
an irritable state of the stomach, are common causes of gastro-ente- 
ritis. Acrid metallic salts, and many vegetable poisons, belong to 
the first class of causes. Worms are usually considered as imme- 
diate causes of gastro-enteritis, but M. Chauvin is disposed to view 
them as more usually the effect rather than the cause of this state. 
He does not believe them capable of perforating the intestines, and 
supposes them to reach the peritoneal cavity through openings made 
by ulceration. Among the sympathetic causes, we find those which 
act upon the skin, as cold causing colitis, and heat inflaming the 



Physiological Medicine. 173 

stomach and small intestines. Malaria, also, might have been in- 
cluded. Acute cutaneous inflammation is often repeated in the di- 
gestive organs. Inflammation of any organ sufficient to excite fever, 
always induces gastro-enteritis; hence there is no fever without this 
condition. The same may be said of wounds producing traumatic 
fever. The suppression of any evacuation is a very common cause 
of this disease. Violent physical exertion is a cause with which most 
persons are familiar. The passions, when highly excited, often give 
rise to gastric inflammation,- in fact, they affect the stomach more 
than the heart. Anxiety always destroys the appetite, and finally 
produces fever. Gloomy ideas, from whatever cause they proceed, 
seldom fail ultimately to produce chronic gastro-enteritis, and unless 
cheerfulness be restored a cure is almost impossible. Intense and 
long-continued study often developes gastritis, and, the brain being 
excited, mania may follow. As mixed causes, M. Chauvin men- 
tions the ingestion of cold water while the body is much heated, the 
action of miasmata, and irritation of the liver. We are willing to 
coincide with M. Chauvin so far as respects the first and last of these 
causes, but we would in preference refer miasmata to the class of 
sympathetic causes, as we can find no evidence that they act imme- 
diately on any other than the cutaneous and pulmonary surfaces. 

Our attention is next called to the phenomena of acute gastro-en- 
teritis; by which term must be understood inflammation of the stomach 
and small intestines. It may commence suddenly or slowly. The 
patient complains of heat, and weight or compression of the stomach 
after meals, with lassitude and general uneasiness. The throat be- 
comes hot and dry with thirst, and the complexion pale or yellowish. 
The mucous membranes of the nose, eye, or oesophagus sometimes 
inflame. The appetite is usually diminished, seldom increased. We 
have seen some cases in which intense hunger accompanied violent 
fever. Digestion is painful, with nausea, sour eructations, constipa- 
tion, or sometimes diarrhoea. The disease often begins with gastric 
oppression. There is loss of appetite with fulness of the stomach; 
the mouth being clammy or bitter, the tongue thick and covered with 
a white or yellow coat. This state is usually removed by low diet. 
Emetics often relieve it, but are liable to develope intense fever. 
Gastro-enteritis often commences without these warning symptoms. 
There is vomiting of mucous or bilious matter, or else purging with 
colic and tenesmus. There is usually tenderness of the epigastrium; 
a very important symptom. This, however, is not always percepti- 
ble, for the gastric nerves being principally ganglionic, their sensi- 
bility is not easily developed. The skin of the epigastrium is often 
No. XV.— May, 1831. 16 



174 Physiological Medicine; 

hotter than that of other parts. The sympathetic symptoms are im* 
portant. Head-ache is almost always present, and the cerebral irri- 
tation is sometimes so intense as to excite delirium* with diminished 
sensibility, muttering, paralysis of the bladder* involuntary dejec- 
tions, and other symptoms of the adynamic fever of the ontoiogists. 
The delirium may be violent, with convulsions, subsultus tendinum r 
picking at the bed clothes, and other symptoms of the ataxic fever of 
the ontoiogists. It would seem that in adynamic fever the irritation 
extends to the substance of the brain, while in ataxic fever the me- 
ninges and surface alone of the brain suffer. The heart is strongly 
irritated in the disease before us. In the commencement the pulse 
is sometimes, but not often, as fully developed as in parenchymatous 
inflammation. Its most common state is rapidity with smallness and 
concentration, sometimes intermittent, or almost insensible and con- 
vulsive. These last symptoms are very unfavourable. The pulse is 
sometimes little affected in the most intense gastritis, and this also 
is a bad symptom. The lungs receive the influence of the stomach, 
as announced by the rapid, laborious respiration, and the gastric 
cough and pulmonary inflammation may come on. The actions of 
the secreting organs are vitiated. The qualities of the bile are 
changed, and its quantity is increased, unless the hepatic irritation 
become intense. The urine is red, in small quantity, and excites 
pain when discharged. Towards the close of fatal cases the patient 
emits a peculiar odour, attributed by Lallemand to the absorption of 
urine. During the progress of the disease, the other mucous mem- 
branes redden, especially at their origins. The end of the urethra 
is red, as is also the mucous coat of the bladder. The conjunctiva 
is injected, the pituitary membrane dry, the mouth clammy at first, 
becomes hot and dry. The state of the tongue is an important index 
to that of the mucous membrane. In moderate gastritis it is usually 
large and whitish or yellowish, but as the irritation increases it red- 
dens, in proportion to the acuteness of the disease. This redness 
of the edges and point of the tongue never exists without gastric in- 
flammation, although acute inflammation may exist without extensive 
redness; and in this case we observe a number of red or violet spots 
projecting above the mucous coat. This last symptom is more com- 
mon in chronic gastro-enteritis. The middle of the tongue is usually 
whitish or yellowish, but in some cases the whole surface is red. It 
is more narrow, in proportion to the intensity of the inflammation. 
When the disease is approaching a fatal termination, the tongue, 
lips, and teeth are covered with a dark, fuliginous coat, which dries 
and cracks. In lymphatic persons and infants, aphthae often appear 



Physiological Medicine. 175 

in the mouth. If the gastritis cease before the enteritis, we may have 
a premature appetite. Excessive thirst shows predominance of in- 
testinal irritation. In gastro-enteritis the skin is hot, and uni- 
formly dry, or covered with momentary perspiration. In the last 
stages the cutaneous irritation excites petechia, and the parts suffer- 
ing pressure run into gangrene. In some instances an abscess ap- 
pears in the region of the parotid, and may prove revulsive: or, 
if too acute, may increase the disease. In a few cases, the arti- 
cular fibro-serous textures inflame sympathetically. The above 
symptoms, must, of course, vary with the constitution of the patient, 
the nature of the cause, and other circumstances. If the gastro-en- 
teritis be considerable, from neglect, or the use of emetics, and the 
liver become implicated, we have bilious fever. Gastro-enteritis rapidly 
developed in a robust, sanguine subject, is principally displayed in 
the great activity of the circulation, and assumes the characters of 
inflammatory fever. The same inflammation occurring in lymphatic 
subjects, is principally exercised on the mucous cryptse, and the 
gastro-intestinal mucus being abundantly secreted, we have mucous 
fever. When the nervous apparatus is excessively irritated, we have 
delirium, stupor, convulsive and putrid symptoms, in short, all the 
common symptoms of malignant fevers. We thus perceive that all 
fevers may be traced to gastro-enteritis associated with irritation of 
various organs. The epidemic and contagious fevers are gastro-en- 
teritis, excited by vegetable or animal poisons dissolved in the at- 
mosphere. M. Goupil gives, from the thesis of M. Gravier, an in- 
teresting account of an epidemic cholera occurring in India in 1817, 
and destroying more than six hundred thousand inhabitants. It is 
unnecessary to follow our author through the history of a disease so 
well known; but the treatment deserves some notice. M. Gravier 
attributes the extreme violence and extensive prevalence of this epi- 
demic, to the fact that immense numbers of the inhabitants used, as 
a preventive, a camphorated and opiate solution, advised by the 
English practitioners. They were also treated with stimulants con- 
taining calomel, opium, camphor, &c. The fatality of this treatment 
was lamentable. Correctly referring the violent vomiting and purg- 
ing, and the extreme muscular debility, to intense irritation of the 
mucous membrane, M. Gravier avoided internal medicine as dan- 
gerous, prescribed absolute diet, and bled the patient.* The effect 
was most happy. The patient whom he found almost speechless, 
was, in a few hours, comparatively free from danger. More than a 

* We are not disposed entirely to reject morphine internally, or to a blistered 
surface; but we have had no experience with it in this disease. 



176 Physiological Medicine. 

second bleeding was seldom necessary. It is to be regretted that 
M. Gravier had not the means of local bleeding, the most important 
part of the treatment of this disease. 

A knowledge of the -phenomena of chronic gastro-enteritis, is not 
less important than that of the acute disease. The observations on 
this subject are taken from MM. Goupil, Poutier, Schacken, 
Archambault and Merot. Chronic gastro-enteritis is that state 
of the disease, in which the local and sympathetic symptoms are 
slight, and the digestion and other functions are not dangerously 
impeded. It may result from acute gastro-enteritis improperly 
treated, or from any of the causes of the acute disease. It is most 
apt to occur in persons of a bilious or nervous temperament, and in 
those devoted to literary pursuits, or subject to melancholy. The 
symptoms are so variable, that it is impossible to describe them in 
any determined order. The patient experiences at the epigastrium, 
a sense of uneasiness, or of pain, more or less acute, and extending 
to the hypochondria. There is often a sense of constriction, extend- 
ing to the oesophagus, and even impeding respiration and deglutition. 
The epigastrium is sometimes tender, and at other times the chest is 
painful, and there is a slight cough. Loss of appetite, (anorexia,) is 
common, and the digestion is painful, with acid or acrid eructations, 
(pyrosis.) The disease augmenting, there is fullness of the stomach, 
thirst, confusion of ideas, with a sense of weight in the head, and 
aversion to exercise; the skin, especially of the hands, becomes hot, 
and the pulse is quickened. A full meal often excites vomiting. 
There is, usually, constant constipation, which, however, is some- 
times interrupted by a temporary diarrhoea. In children, the inflam- 
mation often extends to the mesenteric ganglions; and we then have 
tabes mesenterica, (carreau.) The tongue is usually contracted, and 
red at its point and edges. The redness may be less intense, and 
more extensive, or there may be only small, red points projecting 
through the mucous coat. The middle of the tongue has frequently 
a whitish or yellowish coat, which is more perceptible in the morning. 
The breath is fetid, and the thirst considerable. In the slighter 
shades of the disease, the heart is not affected; but it finally becomes 
irritated, and a slight fever appears, which may become remittent 
or continued; and here there is danger of disorganization. The liver 
sometimes partakes of the irritation, and there is excess of bile, with 
a bitter taste, and a yellowish tinge of the countenance. The quan- 
tity of the urine is diminished, and its colour becomes reddish, or, in 
nervous persons, it is plentiful and limpid, as in hysteria. The 



Physiological Medicine, 177 

brain is usually implicated, and the patient is sad, morose, suspicious, 
and all the characters of hypochondriasis are finally displayed. The 
skin is commonly hotter after meals; but if the inflammation be too ' 
slight to excite the sympathy of other organs, the skin is colder than 
in health. The strength of the patient is much diminished, and 
atrophy finally appears; the skin sinking between the muscles, and 
adhering to them. Such are the principal symptoms of a disease, 
which, from the excessive use of tonics, emetics, cathartics, and 
sudorifics, is but too common among us. This disease, however, 
sometimes assumes a character totally different from that above 
given, and the patient is tormented by that insatiable appetite, to 
which the name of boulimia has been given. 

M. Goupil demonstrates the non-essentiality of several diseases, 
formerly misunderstood, and empirically treated. He points out the 
close resemblance between the above symptoms, and those of dys- 
pepsia; shows that the causes of this disease are, all such as irritate the 
stomach; and that tonics, emetics, and other irritants, almost always 
aggravate the symptoms, after a momentary relief, while the treatment 
hereafter prescribed, always palliates or cures. True debility of the 
stomach, a rare disease, is shown by a large, pale tongue, no pain at 
the stomach, a feeble, but regular pulse, weakness, and total absence 
of all signs of irritation; and always yields rapidly to a wholesome diet, 
and mild tonics. Hypochondriasis, also, presents the symptoms of a 
chronic irritation of the digestive mucous membrane and of the brain: 
and to the treatment of this disease, we may apply the remarks made on 
dyspepsia. The results of gastro-enteritis, when the disease is treated 
with irritants, all tend to the destruction of life, by disorganization 
of the digestive apparatus. One of these results is scirrhus of some 
part of the stomach; announced by a pale yellow countenance, tu- 
mour, and lancinating pain at the epigastrium, and almost always, 
vomiting. When the disease is at the cardiac orifice, the pain is 
seated below the region of the heart, in the back, or the pharynx, 
and is increased on swallowing. When it occupies the body of the 
stomach, the patient is unable to take much food at one meal, and 
vomiting usually occurs soon after eating. If the disease occupy the 
pylorus, there is a hard tumour between the epigastrium and the right 
hypochondrium; and vomiting occurs two or three hours after eating, 
when the food is passing the pylorus. When the scirrhus runs into 
carcinomatous ulceration, the matter vomited is often bloody. It is 
well known to pathologists, that inflammation often destroys the co- 
hesion of the tissues. It has been satisfactorily ascertained, that the 

16* 



1 73 Physiological Medicine. 

perforation of the stomach, formerly attributed by Hunter to the ac- 
tion of the gastric juice,* is the result of inflammation. M. Goupil 
quotes from the papers of MM. Gerard and Laisne, several re- 
markable cases of gastritis terminating in death, from perforation of 
the stomach. 

Under the name of colitis, M. Broussais describes the inflamma- 
tion of the mucous membrane of the large intestine, constituting the 
diseases called diarrhoea and dysentery. This inflammation may 
proceed from all the causes of gastro-enteritis, and especially from 
unripe fruits, and other improper food, and from vegetable and ani- 
mal matter, in a state of putrefaction. M. Goupil observes, that it 
is never contagious, unless allied to typhus; as in some epidemics. 
When the inflammation is slight, it assumes the form of diarrhoea. 
Diarrhoea is attended with wandering pains in the abdomen, espe- 
cially near the umbilicus, and a sense of fullness in the pelvis, re- 
lieved by the subsequent evacuations. The colic is sometimes con- 
siderable, and is relieved by pressure, or external warmth. The 
evacuations are usually small, and of variable frequency; and con- 
sist of softened feces, mucous, bilious, or serous matter, of various 
colours. If diarrhoea be slight, the sympathies are not excited; but 
when more intense, there is thirst, anorexia, foulness and redness of 
the tongue, and lassitude. When the colitis is more intense, it as- 
sumes the form of dysentery. Here, the colic is acute, with small 
and frequent evacuations of mucous, bloody matter, or with ineffec- 
tual efforts to evacuate the feces. The disease progressing, the 
spasm of the bowels and the pain become intense; but the latter is 
little increased by pressure. The strength is exhausted as the dis- 
ease increases. Under these circumstances, the stomach and upper 
intestine become inflamed; the mouth and tongue become dry and 
red; there is thirst, with soreness of the epigastrium, and in short, 
all the symptoms of gastro-enteritis, are added to those of colitis. 
Inflammatory dysentery is a gastro-entero-colitis, occurring in a san- 
guine subject. A combination of mucous fever and dysentery, con- 
stitutes mucous dysentery. If there be a predominance of bile, the 
disease is called bilious dysentery; and if the colitis be complicated 
with malignant fever, we have adynamic or ataxic dysentery. All 
these modifications have been divided, by the ontologists, into so 
many specific diseases. When colitis does not terminate in death 

* We have seen the details of some cases, which we could not explain on any 
known principles. 






Physiological Medicine. 179 

or resolution, it passes into a chronic state. In this case, the colic 
ceases, and the stools become less frequent; and if the stomach be 
free from inflammation, there is, usually, a desire for substantial 
food; which, if granted, produces, a few hours afterwards, a pain- 
ful colic, with increase of the symptoms. Chronic colitis, if not 
cured, is apt, eventually, to induce atrophy, with inflammation of 
some other organ, finally running into dropsy. 

The thesis of M. Scoutetten, forms the fourth article of the pre- 
sent chapter. It presents a valuable exposition of the pathological 
anatomy of the digestive mucous membrane; and corroborates the 
pathological views of M. Broussais, by showing the evidences of in- 
flammation, or even ulceration, left by fevers of all sorts, dyspepsia 9 
boulimia, diarrhoea, dysentery, and a host of disorders, which, be- 
fore the researches of M. Broussais, were misunderstood, and badly 
treated. As this very valuable paper does not contain any of the 
practical principles of the doctrine before us, we pass on to the next 
subject. 

The next chapter contains an able defence of the identity of gastro- 
enteritis with the essential fevers of the ontologists. All the argu- 
ments against the positions assumed, are fairly combated, and the 
proofs adduced are-so convincing, as to be, we think, irresistible, to 
every unbiassed mind. We had proposed to offer, at some length, 
the arguments of our author; but his paper is long, and almost inca- 
pable of further condensation. He proves that all the causes of fe- 
ver are causes of gastro-enteritis. That the want of appetite, nausea, 
pain at the epigastrium, thirst, head-ache, heat and dryness of the 
skin, foulness and redness of the tongue, in short, that all the com- 
mon symptoms of fever, are precisely those of gastro-enteritis. Also, 
that all the varieties of fever depend on the complication of gastro- 
enteritis with inflammation of some other organ, on the intensity of 
the disease, and on the temperament of the patient. We thus have 
bilious fever, when the liver is implicated, or ataxic and adynamic 
fevers, when the brain is intensely irritated. 

We come now to the treatment of gastro-enteritis in its acute form; 
and in this, particularly, is the philosophical character of physiologi- 
cal medicine most evident. In inflammation of the stomach, as of 
other organs, M. Broussais avoids all irritants. He therefore forbids 
the use of emetics, cathartics, sudorifics, tonics, and all the pertur- 
bating means so much employed in fever. He allows that the disease 
is often cured by the revulsive irritations and evacuations, produced 
by these medicines, but observes that in many cases, they fail to pro- 
duce revulsions, and rapidly destroy the patient, by their local 



180 Physiological Medicine. 

effects, or give the disease a chronic, and almost incurable character. 
The means now to be detailed, being more efficacious, and unattend- 
ed with risk, are preferable to the perturbating and hazardous 
practice. 

When a patient presents the preliminary symptoms of fever, as 
loss of appetite, foulness of the tongue, bitterness of the mouth, &c. 
his diet must be reduced to the use of rice water, barley water, 
cooked fruits, &c. with cold water, or lemonade; and if he be ro- 
bust, a dozen leeches may be applied to the epigastrium. This 
usually prevents the attack. When the fever has commenced, the 
number of leeches must be increased, according to the strength of the 
patient; and when they fall off, the bleeding may be continued by 
fomentations. In children, and weak persons, the leeches must be 
used cautiously, and the subsequent bleeding stopped. If the patient 
be very weak before the attack, even leeches may be avoided. They 
may also be avoided, if the disease be preceded by chronic gastro- 
enteritis. Should the disease continue, the leeches must be applied as 
often as is necessary. General bleeding is unnecessary, and sometimes 
even dangerous, unless the circulation be very violent, with great de- 
termination to the brain, lungs, liver, or some other large organ. No 
food must be allowed; and the drinks must consist of lemonade, so- 
lutions of gum arabic, or tragacanth, or some other mucilage, acidu- 
lated with citric or tartaric acid. Emollient fomentations may be 
applied to the abdomen with advantage. If the epigastrium be very 
hot, iced water may be applied; and if delirium come on, the same 
may be applied to the head. When the patient is convalescent, we 
gradually increase the quantity of food; beginning with preparations 
of sago, rice, and barley. In most cases of fever, vesicatories and 
sinapisms are apt to do harm, and must be avoided. Where, how- 
ever, intense cerebral irritation appears, with low delirium, stupor, 
or other cerebral symptoms, we first apply leeches to the temples, 
and ice to the head; and if these alone fail, we may add sinapisms, 
and even vesicatories, to the legs. Blankets soaked in hot water, 
and applied to the legs, are also valuable. Another case in which 
revulsives may be used in fever is, where a haemorrhage occurs. 
The haemorrhage, if there be little debility, and it be moderate, need 
not be interrupted; but if the patient be weak, or the bleeding great, 
we apply blisters or sinapisms, and not astringents; haemoptysis de- 
mands a vesicatory to the sternum, and epistaxis to the back of the 
neck. Inflammation of the lungs, liver, or any other organ, occur- 
ring in fever, will demand local or even general bleeding. Should 
the gastro-enteritis become so violent as to assume the form of typhus, 



Physiological Medicine. 181 

and the prostration become so extreme as to forbid the use of leeches, 
we then resort to acidulated mucilages internally, and apply fomen- 
tations and poultices to the abdomen, with sinapisms to the feet 
and legs. Four or five leeches may be applied to the epigastrium, 
and the bleeding stopped, if the pulse sink, but not so if it rises. 
The bowels must be kept open, during the whole course of the 
disease, not by purgatives, but by mucilaginous enemata.* Such is 
an outline of the physiological practice. 

The treatment of chronic gastro -enteritis, (dyspepsia, boulimia, &c.) 
is very simple. If the patient be robust, confine him for a few days 
to absolute diet, and apply a dozen leeches to the epigastrium. After 
this, the treatment will consist in abstinence from all animal food, 
and the use of sago, rice water, barley water, small portions of very 
light bread, &c. This diet must never be violated. The occasional 
use of leeches, and the frequent use of poultices, will be required. 
The bowels must be kept open by enemata; never by laxatives. We 
do not fully adopt this generally correct precept. Moderate exercise 
will be useful: as also will the cold bath in summer, when the strength 
of the patient will bear it. The treatment must be pursued for 
months, if necessary. 

The treatment of acute colitis will be very similar to that given for 
gastro-enteritis. Diarrhoea and dysentery, the common forms of 
colitis, demand the same low diet as gastro-enteritis. In addition to 
this, we apply leeches to any painful part of the abdomen, and to the 
anus. Cold, mucilaginous drinks, and poultices to the abdomen, 
will also be very useful. Internal medicines are generally improper; 
but when there is no longer fever, nor tenesmus, and no blood is 
discharged, gentle opiates are proper, and may be placed in the rec- 
tum, if the stomach be irritable. The treatment of chronic colitis 
differs from that of the acute disease, in little but activity. Here, 
however, the diet will sometimes require some addition, to support 
the strength. If the disease be slight, and the stomach healthy, a 
gentle tonic will assist digestion; but its effect must be closely ob- 
served. Mucilaginous and slightly narcotic enemata will be useful; 
and if there be no fever, tenesmus, nor frequent discharges, opium 
internally will be beneficial. 

In the treatment of intermittent fever, the principles already given 
must be applied. In the cold stage, avoid stimulants, and allow 

* In a few cases, even after local bleeding, enemata do not act sufficiently; 
here, we are accustomed, if the gastritis be not very acute, to use the mildest 
laxatives. 






182 Physiological Medicine. 

tepid drinks only. In the hot fit, follow precisely the plan above 
directed. This will often cure the disease; if not, resort to the sul- 
phate of quinine. The quinine must not be used in the first inter- 
mission, nor in any subsequent period, while the tongue is red, the 
skin dry, or hot, or if there be thirst, soreness of the stomach, or any 
other febrile symptom. When, by a proper antiphlogistic treatment, 
we obtain a perfect apyrexia, shown by a regular pulse, little thirst, 
no heat of the skin, nor tenderness of the stomach, and a tongue suf- 
ficiently pale in its whole extent, the quinine will be safe and effi- 
cacious. 

Common remittent fever requires the treatment proposed for gas- 
tro-enteritis; but some modification is required in malignant inter- 
mittens and remittents. When the disease is very malignant, and 
the patient is in great danger, we cannot depend on antiphlogistics 
alone, but must resort to the sulphate of quinine in the remission. 
If the stomach reject it, throw it into the rectum,* and rub the skin 
with the tincture of bark. Local bleeding, and other antiphlogistics, 
also, must be used, if the patient be sufficiently strong. If there 
have been several paroxysms, and the pulse be small, feeble, inter- 
mittent, the skin livid, and the patient senseless, avoid even local 
bleeding; apply to the legs and thighs the most rapid rubefacients, 
while a solution of several grains of sulphate of quinine is thrown 
into the rectum, and the skin is rubbed with the tincture of bark. 
The bark and quinine are dangerous in these cases, but without them 
the danger is greater. 

M. Goupil goes on to the consideration of the relations of gastro- 
enteritis with other inflammations. In some preliminary remarks he 
observes, that the principles of the new doctrine are applicable to 
surgery. Traumatic fever is to be treated on the usual principles, 
and local inflammation from wounds must be relieved, if excessive, 
by local bleeding. 

In treating of hepatitis, our author demonstrates that it is always 
caused by, or associated with, gastro-enteritis. All the causes of 
hepatitis act at the same time on the mucous membrane.t Such are 
improper food, tonics, emetics, external heat, &c. Acute hepatitis 
is preceded and accompanied by the usual symptoms of fever; and 
the chronic form is always combined with dyspepsia, hypochondria- 
sis, or other symptoms of chronic gastro-enteritis. The treatment of 
acute and chronic hepatitis differs very little from that of the corres- 

* Apply also several grains in powder to blistered surfaces. 
£ Excepting* wounds of course. 



Physiological Medicine* 183 

ponding forms of gastro-enteritis. The same regimen, local bleed- 
ing, and other means, must be used. Leeches to the right hypo- 
chondrium, also, are proper; and if the disease be acute, general 
bleeding will be required. The treatment must be pursued, until 
there remains neither fever, dyspepsia, pain of the liver or right 
shoulder, nor any other symptom of the hepatic disease. 

In the next article he shows that the mm^Aemataaregastro-enteri- 
tes associated with cutaneous inflammation. They commence with 
all the usual symptoms of gastro-enteritis, (fever,) which have been 
repeatedly eriumerated. After a few days an eruption appears; 
which, if of proper intensity, is completely revulsive, and stops the 
fever. If the eruption be not sufficiently abundant, the cutaneous in- 
flammation and fever co-exist. If the cutaneous inflammation be- 
come too intense, it is repeated in the mucous membrane, and the 
fever is increased. This last is the secondary fever of authors. Erup- 
tive fevers require precisely the same treatment as simple fevers, 
until the appearance of the eruption. Here, also, the same treatment 
is proper, unless the cutaneous inflammation become intense; in 
which case we may apply emollient fomentations, and place leeches 
near the most highly inflamed points; especially on the face. This 
is particularly useful in confluent small-pox. If rosalia become com- 
plicated with angina, or measles, as is usual, with catarrh, leeches 
may be applied to the neck, and under the clavicles. 

Gastro-enteritis is often associated with articular inflammation, in 
the forms of gout and rheumatism. When the disease commences 
in a small joint, it is called gout; when it commences in a large joint, 
or in several small articulations, it is called rheumatism. There is 
no essential difference between these diseases. They may be con- 
fined entirely to the joint; but more usually they are associated with 
acute or chronic gastritis, or gastro-enteritis. The causes of gout 
are cold, metastasis of some irritation, improper food, especially the 
luxuries of the wealthy, the abuse of tonics, and all the other causes 
of gastro-enteritis. It is usually preceded by the symptoms of chronic 
gastritis, and it is well known, that any error of diet always aggra- 
vates it. The treatment of gout and rheumatism is very simple. If 
the disease appear to be entirely local, the patient is to be confined 
to a strict diet, and leeches applied freely to the joint, while the 
bowels are opened by enemata. If considerable fever arise, and the 
patient be strong, general bleeding may become necessary, with 
leeches to the epigastrium. In general, there will be symptoms of 
gastritis, either acute, or in the chronic or dyspeptic form. This 
will demand leeches to the joint and the epigastrium, with a low, 



184 Physiological Medicine. 

mucilaginous diet, and other treatment already mentioned as proper 
for gastro-enteritis. All internal medicines must, for an obvious 
reason, be avoided. These few facts and principles are taken from 
the valuable and extensive observations of our author, who is in some 
degree indebted to M. Roche. 

Our author has compiled, from the works of Broussais, Lallemand, 
and Richond, some rational precepts on the subject of cerebral irri- 
tation, and its connexion with gastro-enteritis. It is universally ac- 
knowledged, that the principal phenomena of apoplexy, mania, epi- 
lepsy, tetanus, catalepsy, and some other diseases, depend on ner- 
vous disorders. M. Broussais has ascertained that all the alterations 
of cerebral structure, as well as serous and bloody effusions into or 
upon the brain, are effects of inflammation. We have already men- 
tioned, that the delirium, stupor, subsultus tendinum, and other 
ataxic symptoms of violent fever, depend on acute irritation of the 
brain, excited by the intensity of the gastro-enteritis. In the violent 
gastro-enteritis produced by poisons, there is a series of nervous 
symptoms; such as delirium, vertigo, trembling, paralysis, &c. 
Opium, when swallowed in a large dose, produces a state resembling 
apoplexy. M. Lallemand has seen cephalitis produced, in the treat- 
ment of paralysis, by the internal use of the nux vomica, emetics, 
purgatives, and various other irritants. The premature use of the 
sulphate of quinine, in the treatment of fever, has produced paraly- 
sis. Extreme intoxication closely resembles apoplexy. This state 
does not proceed from the absorption of the alcohol; for it is removed 
by vomiting, and by dilute ammonia. Some wines, also, which con- 
tain little alcohol, produce intoxication more easily than some others 
containing more of the active principle. The same may be said of 
the mixture of wines. The diseases of the nervous system, as palsy, 
apoplexy, and others, are generally associated with symptoms of 
gastric disorder; and an error in diet often suddenly produces these 
diseases. The chronic diseases of the brain, as mania, (especially 
when periodical,) and idiotism, are almost always preceded and ac- 
companied by symptoms of gastric irritation. From all these facts, 
as well as from others too numerous for present notice, our author 
justly concludes, that mania, hypochondriasis, &c. as well as most 
other cerebral diseases, are usually excited and kept up by gastro- 
intestinal irritation, in the same way as gout, hepatitis, &c. It is 
almost superfluous to say, that practice must be modified by the 
knowledge of these facts; and that internal irritants must be cau- 
tiously used in apoplexy and analogous diseases. 

The last subject considered by M. Goupil is asthenia or debility. 



Physiological Medicine, 185 

M. Broussais has shown, that the number of diseases depending on 
debility is very small. Debility of an organ may proceed from the 
abstraction of its usual stimuli, or from an increase of action in an- 
other organ. The stomach is thus debilitated, by being deprived of 
all food, except insipid, mucilaginous liquids. The use of a blister, 
as a revulsive, is an example of the second mode in which debility is 
produced. Debility from abstraction of stimulus, is usually followed 
by reaction. Hunger ends, if not gratified, in gastritis; and a part 
to which cold has been applied, becomes irritated on the removal of 
the cold; unless the latter be extreme, or long-continued. Debility 
is sometimes a consequence of excitement; as in exhaustion from 
violent exercise, and real debility of the stomach, subsequent to gas- 
tritis. Excessive increase of the organic actions of any part, may 
debilitate its function; as we see in the diminished contractility of 
an inflamed muscle. Debility produced by abstraction of stimulus, 
must be removed by the cautious application of gentle stimuli. De- 
bility of the stomach must be treated with easily digestible food, and 
gentle tonics; active stimulants will create gastritis. Debility of an 
organ from irritation of another, will demand the removal of the irri- 
tation. Muscular debility from gastro-enteritis, as in typhus fever, 
must be relieved by debilitants applied to the mucous membrane; 
and not by internal stimulants, which will exasperate the cause of 
the debility. 

In concluding our observations on the present work, it would be 
ungrateful to neglect the author, but unnecessary to detain the 
reader with recommendations of a performance, the value of which 
is self-evident. M. Goupil has conducted his exposition in a man- 
ner scarcely susceptible of improvement; and strong indeed must be 
that scepticism, which can resist the appeal of conclusions logically 
drawn from undeniable premises.* 

Both 'the doctrines and the practice, a faint sketch of which we 
have given, once appeared to us, as trivial as they can seem to any 
of our readers. But a full investigation has long since convinced us, 
that the doctrines contain fewer errors than those of any other sys- 
tem, while the practice, if any difference be allowed between rash 
violence and scientific prudence, is the most active ever pursued. 
Of this we have daily proofs. The idea, very prevalent among many 
who have not seen patients treated on the preceding principles, that 

* We announce with pleasure, that Dr. J. C. Nott, of Columbia, S. C. has 
prepared, and will publish as soon as practicable, a translation of this valuable 
work. 

No. XV.— May, 1831. 17 



186 Physiological Medicine. 

it is too mild for acute diseases, is entirely erroneous; indeed, it is 
to these very cases that it is applied with the most rapid and benefi- 
cial effect. A friend once observed to us, that under the physiologi- 
cal treatment, common intermittent fevers would continue six weeks. 
Yet we have since known that physician to treat such cases with 
perfect success, in almost precisely the manner which he formerly 
considered as entirely inert; and this, too, under circumstances by 
no means propitious to the physiological system; as he had not the 
means of local bleeding, "the very head and front" of the physio- 
logical treatment of gastro-enteritis. Let others follow the liberal 
example here set before them, deciding the question by a full and 
fair trial. 

It is much to be regretted, that throughout our country, the system 
of Broussais is constantly denounced by practitioners who have 
neither tried it themselves, nor seen it tried by others; nay, by 
many who are totally ignorant of its details. To such, we would 
apply an observation of an English writer on another subject, "we 
have laughed at it long enough; it is now time to learn it." 

To such as have studied the works of Broussais and his pupils, the 
former is known as a philosopher of the most brilliant talents, im- 
proved by vast experience, and possessing a degree of tact inferior, 
perhaps, to that of no one of his cotemporaries. His name and his 
opinions should be respected, as those of a veteran philanthropist, 
who has, through a long series of years, laboured hard and incessantly 
for the benefit of mankind; and if there be still many who denounce 
him without reason, let them 

4C Pray to the gods to intermit the plague 
That needs must light on this ingratitude." 

It is still a pleasing reflection, that the cause which we have so 
weakly but earnestly pleaded, is gaining ground rapidly, and must 
inevitably prevail; while the declining years of Broussais will be 
made happy, by the certainty, that in the end, few benefactors of 
the human race will receive a greater tribute of gratitude than the 
author of Physiological Medicine. E. D. Faust. 



( 187 ) 



BIBLIOGRAPHICAL NOTICES. 

XV. Jin Eulogy on Dr. Godman, being an Introductory Lecture, delivered Novem- 
ber 1, 1830. By Thomas Sewalx, M. D. Professor of Anatomy and Physio- 
logy in the Columbian College, D. C. Washington, 1830, pp. 24, 8vo. 

It has been a subject of extreme regret to us, that we have not been able, long 
ere this, to present to our readers, a biographical sketch of our valued and la- 
mented coadjutor, but it was the request of those who are most interested in 
the subject, and who alone can supply the materials for a history of his early 
life, that nothing should be published until these materials were furnished, and 
up to the present moment we have never been put in possession of them. 

The collection and arrangement of the promised information, have indeed 
been so long delayed by various unfortunate circumstances, that we now almost 
despair of ever receiving it, and therefore take advantage of the eloquent 
and instructive eulogy of Professor Sewall, to present a brief notice of Dr. 
Godman, and for this purpose, shall borrow largely from the address in question. 

Dr. John D. Godman was born at Annapolis in Maryland, and at a very early 
age was deprived of the fostering care of parents. 

His father had lost the greater part of his estate before his death, and that 
which remained never came into the hands of his children. Young Godman, 
therefore, was early taught to rely on his own talents and industry. In this 
situation he was indented an apprentice to a printer in the city of Baltimore; 
but the occupation was not congenial to his taste, and after a few years, he left 
the business in disgust, and at the same time entered as a sailor on board the 
flotilla, which was then, (the fall of 1813,) stationed in the Chesapeake Bay, 
and he was one of those who under Commodore Barney, so gallantly defended 
the heights of Bladensburg, and arrested for a while the advance of the British 
army upon Washington. 

"At the close of the war, having arrived at the age of fifteen, he was permit- 
ted to pursue the inclinations of his own mind; and he immediately commenced 
the study of medicine. He first placed himself under the instruction of Dr. 
Lucket, of Lancaster, Pennsylvania, but soon removed to Baltimore, and en- 
tered the office of Dr. Davidge, at that time Professor of Anatomy in the Uni- 
versity of Maryland. 

"Here he pursued his studies with such diligence and zeal, as to furnish, 
even at that early period, strong indications of future eminence. So indefatiga- 
ble was he in the acquisition of knowledge, that he left no opportunity of ad- 
vancement unimproved, and notwithstanding the deficiencies of his prepara- 
tory education, he pressed forward with an energy and perseverance that 
enabled him not onty to rival, but to surpass all his fellows. 

" As an evidence of the distinguished attainments he had made, and of the 
confidence reposed in his abilities, he was called to the chair of Anatomy in 
the University, some time before he graduated, to supply the place of his pre- 
ceptor, who was taken from the lectures in consequence of a fractured ex- 
tremity. This situation he filled for several weeks with so much propriety — 
he lectured with such enthusiasm and eloquence, his illustrations were so clear 
and happy, as to gain universal applause; and at the time he was examined for 
his degree, the superiority of his mind, as well as the extent and accuracy of 
his knowledge were so apparent, that he was marked by the Professors of the 



188 Bibliographical Notices. 

University as one destined at some future period, to confer high honour upoL 
the profession. 

" Soon after he graduated, he repaired to a small village in Anne-Arundel 
county, in his native state, and established himself as a practitioner of medicine. 
Here he entered on the active duties of the profession, with the same energy and 
diligence, which had distinguished him while a pupil, devoting all the hours 
he could spare to professional and other studies. It was at this time that he 
commenced the study of Natural History, a science in which he became so dis- 
tinguished an adept, and for which he ever after evinced so strong a passion. 
But the place was too limited for the exercise of his powers; and not finding 
those advantages which he wished for the cultivation of his favourite pursuits, 
he removed to Baltimore. Here he could enjoy more ample opportunities for 
the study of Anatomy, which he considered as constituting the foundation of 
medical science. 

" About this time he formed a connection by marriage; an event which con- 
tributed equally to his domestic happiness and literary advancement. Soon 
after his marriage he removed to Philadelphia, but had scarcely settled in that 
city, when he received a pressing invitation to accept the Professorship of 
Anatomy in the Medical College of Ohio, an institution then recently esta- 
blished. During his western tour he encountered difficulties which would 
have broken down a spirit less energetic than his own; but he bore up under 
his accumulated labours and privations, with unshaken firmness and steady 
perseverance. He however remained but one year, and returned to Philadel- 
phia — and here commenced that career of research and discovery, which laid 
the foundation of his future eminence. 

"More ambitious of fame, and more eager for the acquisition of knowledge, 
than for the accumulation of wealth, Dr. Godman on settling in Philadelphia, 
rather retired from the field of practice, that he might employ all his time, and 
exert all his powers in scientific pursuits. He thus found himself at once re- 
moved from the pitiful rivalries and jealousies of the profession, and placed in 
a situation in which he could enjoy the friendship, without alarming the fears of 
his brethren. 

"His main object was to make himself a thorough anatomist, and to qualify 
himself for teaching that science. To this end he opened a room, for giving 
private demonstrations; and after a few winters, he drew around him a class of 
one hundred students. He now found himself occupying a field which fur- 
nished ample scope for the exertion of all his powers, as well as for the gratifi- 
cation of his highest ambition; and it was while engaged in the discharge of 
the duties of this situation, that the foundation was laid of that fatal disease of 
which he died; for so eager was he to acquire knowledge himself, as well as 
to impart it to those around him, that he would not only expose himself to the 
foul atmosphere of the dissecting room during the whole day, but often subject 
himself to the severest toil for a considerable part of the night; and the mo- 
ments which were spared from his anatomical labours, instead of being spent 
in relaxation, or in exercise in the open air, for the benefit of his health, were 
employed in composing papers for the medical journals, in copying the results 
of his anatomical and physiological investigations, in preparing parts of his 
natural history; or in carrying on other literary and scientific studies. It is im- 
possible that a constitution naturally delicate, could long remain unimpaired 
under such strenuous, and unremitting exertion. 

" After Dr. Godman had prosecuted his anatomical studies in Philadelphia 
for four or five years, his reputation as an anatomist became so generally 
known, his fame so widely extended, that the eyes of the profession were di- 
rected to him from every part of the country; and in 1826, he was called to fill 
the chair of Anatomy, in Rutgers Medical College, established in the City of 
New York. There could scarcely have been a stronger testimony of the high 
estimation in which he was held, or of his reputation as a teacher of Anatomy, 
than his appointment to this station; an institution around which several of 






Sewall's Eulogy on Dr. Godman. 189 

the most eminent professors in the country had already rallied; and which was 
called into existence under circumstances of rivalry that demanded the highest 
qualifications in its instructors. This situation, as that of every other in which 
he had been placed, he sustained with a popularity almost unparalleled. He 
never exhibited in public, but he drew around him an admiring audience, who 
hung with delight upon his lips. But the duties of the chair, together with his 
other scientific pursuits, were too arduous, and the climate too rigorous for a 
constitution already subdued by labour and broken by disease; and before he 
had completed his second course of lectures, he was compelled to retire from 
the school, and seek a residence in a milder climate. He repaired with his fa- 
mily to one of the West India Islands, and remained till the approach of sum- 
mer, when he returned, and settled in Germantown. In this place, and in 
Philadelphia, he spent the residue of his life. 

"From the time Dr. Godman left New York, his disease advanced with so 
steady a pace as to leave but little hope, either to himself or his friends, of his 
final recovery. He however continued almost to the last weeks of his life, to 
toil in hisliterary and scientific employments; and this too, with all that ardour 
and enthusiasm, which distinguished the more youthful part of his career. 

" But for what purpose did he thus toil? Not for the acquisition of wealth, 
for this he could not enjoy; not for posthumous fame, for this he did not de- 
sire. It was, as he affectingly tells us, for the more noble purpose, the sup- 
port of his family, and the good of his fellow creatures. 

"The productions of Dr. Godman's pen, and the fruits of his labour, are too 
numerous to be specified. Among them will be found, 'Anatomical Investi- 
gations, comprising a description of various Fasciae of the Human Body;' 'An 
account of some Irregularities of Structure and Morbid Anatomy ;' ' Contri- 
butions to Physiological and Pathological Anatomy;' ' A System of Natural His- 
tory of American Quadrupeds;' 'An edition of Bell's Anatomy, with notes;' 'Ram- 
bles of a Naturalist;' all the articles on Natural History, in the American Ency- 
clopaedia, to the letter D. besides numerous papers which have appeared in 
the periodical journals of the day. At one time he was the principal editor of 
the "Philadelphia Journal of the Medical and Physical Sciences." He publish- 
ed some time before his death, a volume of Addresses which he had delivered 
<on different public occasions. 

"Most of these admired productions have been before the public for a con- 
siderable time; have been received with high approbation, and several of them 
favourably noticed, and even republished in foreign countries. 

" Those of his works which are purely medical, have been read with great in- 
terest by the profession, and contain much new and valuable information. His 
investigations of the Fasciae of the Human Body, and his description of this in- 
tricate part of the animal structure, while they disclose some important disco- 
veries, exhibit the whole subject in a manner so plain and simple, as to divest 
it of its obscurity, and bring it within the comprehension of the youngest stu- 
dent — a subject which, till his researches were made known, was but little un- 
derstood even by the best anatomists. His contributions also to Physiological 
and Pathological Anatomy, though but the scattered fragments of a great work 
which he had designed, contain discoveries and observations which will be read 
with the deepest interest by the enquirer after truth. Of his works not imme- 
diately connected with the profession, his Natural History of American Quad- 
rupeds is the most elaborate, and is published in three volumes. 

"This production will long remain a splendid monument of the genius and in- 
dustry of its author, and be regarded as a model of composition for works of 
this description. It should have a place upon the table of every family, and be 
put into the hands of all the youths of our country. Among the latest produc- 
tions of his pen, are his essays entitled Rambles of a Naturalist, which were 
written in the intervals of extreme pain and debility. For strong, lively, and 
accurate description, they have scarcely been surpassed. He always came to 
bis subject as an investigator of facts, — one who had nothing to learn, but every 

17* 



190 Bibliographical Notices. 

thing" to discover; and, like the celebrated Buffon, never availed himself of the 
labour of others, till he had exhausted his own resources. It was this spirit 
which enabled him to disclose so many new truths, and which gave to all his 
works the stamp of originality. The value which he placed on original obser- 
vation, as well as the zeal with which he sought information from this source, 
may be learned from a single incident, 'that, in investigating the habits of the 
shrew mole, he walked many hundred miles.' 

"The volume of his Public Addresses have been greatly admired for the pure 
and elevated sentiments they contain as well as for their high- wrought eloquence. 
"But his published works constitute but a part of the labours of his pen, and 
many things which he sent forth, were only fragments of a great system, or the 
commencement of future researches. He had formed vast plans for prosecuting 
new investigations in various departments of science, which he did not live to 
accomplish. 

"Though he wrote with great rapidity, and sometimes without much care, 
yet all his works bear the impress of a mind naturally vigorous, bold and origi- 
nal, and much disposed to draw from its own resources; and most of them are 
written in a style of great elegance and beauty. 

" Dr. Godman's intellectual character was very extraordinary. He possessed 
naturally, all the characteristic features of a mind of the highest order. Natu- 
rally bold, ardent and enterprising, he never stopped to calculate consequences, 
so far as they regarded himself; but rushed forward with impetuosity to perform 
whatever he undertook. Great and lofty intellectual purposes seemed to be 
the natural element in which he lived. His perception was quick and accurate; 
his memory exceedingly retentive, and he possessed an uncommon facility of 
abstracting his attention from surrounding objects, and of concentrating all his 
powers upon the subject of his pursuit. It was this latter trait of mind, no 
doubt, which gave such effect to all his efforts: while he was indebted to the 
power of his memory for the remarkable facility he possessed of acquiring lan- 
guages: for although his early education had been exceedingly limited, he had 
acquired such a knowledge of the Latin, Greek, French, German, Danish, Spa- 
nish and Italian languages, as to read and translate them with fluency, and to 
write several of them with elegance. His quick and discriminating powers of 
observation naturally inclined him to notice the habits and economy of animals, 
and gave him his taste for the study of Natural History. 

"But the most striking character of his mind was undoubtedly philosophical 
imagination. It was this trait, which conferred upon him such powers of de- 
scription and illustration, and imparted freshness and splendour to every thing 
he touched. All his conceptions were strong, clear, and original, and he 
possessed the power of holding before him whatever object engaged his atten- 
tion, till all its parts and relations were brought to view. By those who have 
listened to his extemporaneous discussions, it is said, that while he was speak- 
ing, a thousand images seemed to cluster around the subject, and that he had 
just time to select such as imparted beauty, or furnished the happiest illustration 
of the object he wished to explain. Yet, while he possessed all this richness 
and fertility of mind, taste and judgment ever controlled its operations. 

"He was a laborious and untiring student, and possessed in an high degree 
the requisites of all true intellectual greatness — the habit of patient investiga- 
tion, long-continued attention, and a singular love of labour. 'How often, 5 
says one, (to whom he unbosomed the secrets of his heart,) 'have I entreated 
him, while poring half the night over his books and papers, which were r to 
yield him nothing but empty honour — how often have I begged him to consider 
his health; but his ambition and thirst for knowledge were such, that having 
commenced an investigation, or a language, no difficulty could stop him; and 
what he had no time to accomplish in the day, he would do at night, instead of 
enjoying that rest of which he stood in so much need.' 

"It has been truly and happily said by one who knew him intimately, that 
his eagerness in the pursuit of knowledge, seemed like the impulse of gnawing 



SewalPs Eulogy on Dr. Godman. 191 

hunger, and an unquenchable thirst; which neither adversity nor disease could 
allay. Variety of occupations was the only relaxation which he sought for or 
desired. 

"He composed with rapidity, but not without a high degree of intellectual 
excitement, and the most abstracted attention. Under such an influence, 
some of his best essays were sent to the press as they first came from his pen, 
without the smallest correction. 

" Considering the defects of his early education, his acquisitions for his years 
were astonishingly great. Indeed, there were but few subjects of general 
literature with which he was not, more or less, acquainted. 

" But it was his accurate knowledge of Anatomy and Physiology, and his un- 
common power of teaching these branches of medicine, which give him his 
strongest claims to our regard as a man of science; and had his life and health 
been prolonged, so that he could have directed the whole energy of his mind 
to the cultivation of this department of our profession, we have reason to believe 
that he would have laid open new sources of knowledge, discovered new laws, 
and reduced to order those scattered materials already known; and that the 
whole study would thus have been simplified, and enriched by his labours. 

"His method of teaching Anatomy was entirely analytical; and in this re- 
spect, peculiar, that he performed all his dissections in the presence of the 
class, demonstrating the different parts of the animal structure in succession, as 
they were unfolded by the knife. But this method, however well suited to a 
private class in the dissecting room, causes too much confusion and delay to be 
practiced with success, while lecturing, by one less dexterous and skilful than 
its author himself. 

"Dr. Godman, in his manners, was plain, simple, and unostentatious; yet he 
possessed that warmth and affability, which rendered him accessible to all, and 
the delight of the social circle. His feelings in every thing were ardent and 
decided. He was devotedly attached to his friends — towards his enemies he 
was impatient, and felt keenly their revilings. In his conversation, he was 
fluent, and though unstudied, was often brilliant, and always full of point and 
power. 

"He was particularly distinguished for simplicity, and directness in the utter- 
ing of his thoughts, which always indicated to those he addressed the absence 
of selfishness and concealment. No enigmatical expressions, no inuendoes, 
were ever heard from his lips. Dark and distant insinuations were his utter 
abhorrence. In whatever he said, and in whatever he did, he put forth his 
whole soul. He was always cheerful, and apparently happy, even amidst the 
deepest adversity, and the keenest suffering. 

" When we consider the circumstances under which Dr. Godman made his 
way to the profession, and afterwards prosecuted his studies, the multiplicity 
of objects which he pursued, and the light he shed on every department of 
science which he touched — when we consider the power of his intellect, the 
versatility of his genius, and the intensity of his application, we cannot but 
regard him as altogether an extraordinary personage, such an one as has seldom 
been permitted to dwell among men, to share their sympathies, and mingle in 
their elevated pursuits." 

The following just and elegant tribute from the pen of a distinguished scho- 
lar, who knew him well, may with propriety be quoted here. 

"The tributes,' says Mr. Walsh, * which have been paid in the newspapers, 
to the late Dr. Godman, were especially due to the memory of a man, so variously 
gifted by nature, and so nobly distinguished by industry and zeal in the acquisi- 
tion and advancement of science. He did not enjoy early opportunities of self- 
improvement, but he cultivated his talents, as he approached manhood, with a 
degree of ardour and success, which supplied all deficiencies; and he finally 
became one of the most accomplished general scholars, and linguists, acute and 



192 Bibliographical Notices. 

erudite naturalists, ready, pleasing 1 , and instructive lecturers and writers, of his 
country and era. The principal subject of his study was Anatomy in its main 
branches, in which he excelled in every respect. His attention was much di- 
rected also to Physiology, Pathology, and Natural History, with an aptitude 
and efficiency abundantly proved by the merits of his published works, which 
we need not enumerate. 

" We do not now recollect to have known any individual who inspired us 
with more respect for his intellect and heart, than Dr. Godman; to whom know- 
ledge and discovery appeared more abstractly precious; whose eye shed more 
of the lustre of generous and enlightened enthusiam; whose heart remained 
more vivid and sympathetic, amid professional labour and responsibility, always 
extremely severe and urgent. Considering the decline of his health, for a long 
period, and the pressure of adverse circumstances, which he too frequently ex- 
perienced, he performed prodigies as a student, an author, and a teacher; — he 
prosecuted extensive and diversified researches; composed superior disquisi- 
tions and reviews, and large and valuable volumes; and in the great number of 
topics which he handled simultaneously, or in immediate succession, he touched 
none without doing 1 himself credit, and producing some new developement of 
light, or happy forms of expression. 

"He lingered for years under consumption of the lungs; understood fully the 
incurableness of his melancholy state; spoke and acted with an unfeigned and 
beautiful resignation; toiled at his desk to the la'st day of his thirty-two years, 
still glowing* with the love of science, and the domestic affections. The repu- 
tation, the writings, and the family of this victim of the most exalted ambition 
and refined propensities, should be greatly and widely cherished." 



XVI. Dublin Medical Transactions, a series of papers by members of the Associa- 
tion of Fellows and Licentiates of the King and Queen's College of Physicians 
in Ireland. New series. Vol. I. Pt. I. Dublin, 1830. pp. 383, 8vo. 
Plates HI. 

We hail with pleasure the appearance of this volume which fully sustains the 
high character acquired by the Society by its previous publications, and proves 
that the practitioners of Dublin are not behind those of the sister kingdoms in 
the zeal with which they labour for the advancement of medical science. 

The present volume contains nineteen papers. The first is an account of 
two cases of recovery from laceration of the uterus and vagina, by Robert 
Collins, M. D. It was asserted by Dr. Hunter, and the opinion was subse- 
quently strongly enforced by Dr. Denman, that rupture of the uterus was so 
necessarily fatal an accident, that any attempt to relieve the woman was useless 
and even cruel. In Vol. II. p. 222, Vol. III. p. 223, Vol. V. p. 531, and Vol. 
VI. p. 351, of this Journal, no less than eight cases successfully treated will be 
found, showing most conclusively the erroneous and mischievous character of 
such an opinion. The paper of Dr. Collins is principally valuable, as affording 
further evidence of the impropriety of practitioners abandoning such cases 
to their fate. In the first case there was an extensive laceration of the vagina 
and cervix uteri, caused by a midwife mistaking the hand for the foot, and 
attempting to extract the child when the shoulder presented. In the second 
case an extensive laceration occurred at the junction of the vagina and cervix 
uteri, through which the intestines protruded. The cause of the rupture 
does not very clearly appear. Both patients recovered. We may mention 
here that Dr. Henschel, of Breslaw, has recorded in a recent number of Sie- 



Dublin Medical Transactions. 193 

bold's Journal fur Geburtshuelfe, (Vol. VIII.) a case of prolapsus and rupture of 
the uterus during 1 delivery, which terminated favourably. The rupture was at 
the upper part of the cervix uteri, was very small, only about the extent of 
half an inch. 

The next article contains an excellent account of two cases of pulmonary 
apoplexy, illustrative of the value of mediate auscultation, by John C. Fergu- 
son, A. »M., M. B. The first case was that of a robust man, aged thirty-six, 
who had been for some months labouring under cough, and who, whilst 
putting on his shoes, complained of loss of vision, seemed to faint, and 
died without a struggle. The patient had not expectorated any blood for 
fourteen hours before death, nor in the agony was there any escape of blood 
from the mouth or nares, which might lead to a suspicion of the real seat of 
disorganization. The general symptoms did not lead to a suspicion of pulmo- 
nary apoplexy, and the patient was not treated for that disease. Had a stetho- 
scopic examination been made, the disease would have been recognised, and with- 
out such an examination, an accurate diagnosis in diseases of the lungs is often im- 
practicable. On examination forty-eight hours after death, the superior lobe of 
the left lung was completely injected with blood, so that the structure of that 
organ seemed absolutely broken up by the excessive effusion of blood into it. 
The apoplectic mass in this case was, however, soft and flabby, and not resem- 
bling the firmness of hepatized lung as described by Laennec. There was a 
laceration of the pleura in the superior and posterior part of the affected lobe, 
opening upon the point where the sanguineous effusion into the substance of 
the lung seemed most intense, and about three quarts of blood was effused into 
the pleural sac. 

The second case occurred in a female, aged fifty-six, who for two months was 
affected with cough and constipation. When Dr. Ferguson visited her on the 
10th of November, she was labouring under a profuse haemorrhage, which had 
commenced the night before Her pulse was 110, weak and small, countenance 
pale and anxious. On percussion, the whole chest sounded well except the left 
subclavian region, which was dull. Auscultation. Respiratory murmur in the 
greater part of the superior lobe of the left lung either absent or very feeble $ 
in points, a well marked rale crepitant, more particularly around the part where 
respiration is absent: puerile respiration in the rest of the same lung, with 
heavy mucous rale about the leading bronchi. In the right, in spots, the rale 
sonore was heard. From this examination Dr. F. could not hesitate to decide 
at once upon the existence of pulmonary apoplexy, and despite the age and 
considerable debility of the poor woman, he took sixteen ounces of blood from 
her arm which induced faintness. Dr. F. was encouraged to bleed by observ- 
ing, that the strength of the heart's action, as examined by the stethoscope, 
was disproportionate to the smallness and weakness of the pulse — an observa- 
tion originally made by Laennec, and which should be borne in mind in decid- 
ing on venesection in all cases of haemorrhage. The rest of the treatment con- 
sisted in the administration of purgatives, cough mixture with tartar emetic, 
and the strictest abstinence. The patient speedily recovered. 

The following observations of Dr. F. on the subject of blood-letting the 
most powerful means we possess for the cure of this disease, are worth quoting. 

"In few diseases," says Dr. F. " where it is beneficial, is its employment 



1 94 Bibliographical Notices. 

more markedly contra-indicated in the great majority of cases by general 
symptoms. Of course we meet with exceptions to this, where the general 
plethora, &c. demand bleeding at the hands of any man, however ignorant he 
may be of the real disorganization; but on the contrary, for one such case, how 
many does every practical man meet, where almost every symptom would seem 
to contra-indicate the most effectual mean of relief? It is too often argued, 
that by opening a vein we merely add to the existing evil; that we are still 
abstracting from that source of strength which has been already so seemingly 
exhausted, and which may be hereafter so much wanted; and the practice 
founded on such reasoning, I fear, too often consists in the exhibition of tonic 
and astringent medicines. This is a most fatal error. A copious venesection 
seldom indeed amounts to nearly the quantity of blood, which a patient, labour- 
ing under pulmonary apoplexy, will expectorate in a few minutes, and this 
latter is infinitely more debilitating than the former. Besides, the loss of 
blood in one way, venesection, tends to diminish the existing evil, and promote 
its resolution, while the other, on the contrary, only adds to the disease, and in- 
creases the danger. No doubt cases will present themselves to us, where, 
from their being of some standing, the patient may be so spent by the fre- 
quency and extent of the haemoptysis, that to have recourse to general blood- 
letting might be a hazardous experiment: and I conceive it no easy matter to 
determine with justness what constitutes this condition. Decidedly, an account 
of his own feelings of debility given by our patient is not sufficient, and we all 
know how very deceitful an index the pulse is. When we hesitate as to the 
propriety or impropriety of blood-letting, as I have before stated, I believe our 
very best guide, indeed the only one in which any confidence is to be placed, 
to be the comparative strength or weakness of the heart's action, as examined 
by the cylinder. If it be strong, firm, and regular, no state of pulse nor seem- 
ing prostration of strength of our patient should deter us from using the lancet; 
but if the contrary, we should then prefer having recourse to other means 3 
which I shall not now dwell upon." 

Johk Crampton, M. D. furnishes the next three articles. The first is a case 
of melanosis; the second a case of perforation of the stomach, with the escape 
of a lumbricus into the cavity of the abdomen; and the third, an account of an 
anomalous state of the heart. 

The case of melanosis occurred in a weaver, thirty-four years of age, and 
was considered during life, as an instance of enlarged and tuberculated liver. 
There was ascites to great extent, and the disease was of six years standing. 
On examination after death the pleurae were found studded with melanotic 
tumours, about the size of a pea, and which, when cut into, resembled coagu- 
lated blood. The liver was immensely enlarged, weighing nineteen pounds, 
and measuring three feet eight inches in circumference. On its surface it was 
thickly studded with round black tubercles, varying in size. When cut into, 
these tubercles presented a soft pulpy matter, easily broken down, and re- 
sembling Indian ink in colour. The interior of the liver was also studded with 
these black tubercles, so that when cut the surface resembled a slice of plum 
pudding. 

This, like most other cases of the same description, was not attended by any 
symptoms which would form a diagnosis between it and other changes of struc- 
ture in the lungs, liver, and other important organs. 

The instance of perforation of the stomach occurred in a woman aged fifty, 
admitted into Hardwicke hospital. She had obstinate constipation, vomiting, 
intense pain in the epigastrium, with inflation and tenderness of some day's 



Dublin Medical Transactions. 195 

standing 1 , which was followed by diarrhoea: she died a fortnight after admission, 
much emaciated. On examination, there were found three quarts of puriform 
fluid in the abdominal cavity, the whole peritoneum and viscera covered with 
lymph, and the inflammation had extended to the thoracic organs. A large lum- 
bricus was found between the liver and stomach. A round perforation was dis- 
covered about the middle of the lesser curvature of the stomach. Externally 
its margin was smooth and defined, and lined by a membrane which appeared 
to be a continuation of the mucous membrane of the stomach; internally its 
margin was also defined, and surrounded by a hard elevated edge, irregular, 
somewhat triangular, inclosing an aperture into which the worm could be in- 
serted. None of the contents of the stomach appear to have escaped into the 
abdominal cavity, probably from the liver being pressed against that part of the 
stomach in which the aperture was situated. 

The chief interest in the case of anomalous state of the heart is that life 
should be maintained ten years with so imperfect an organ, and one apparently 
so inadequate to the performance of its functions. The subject was a boy, aged 
ten, who died dropsical, accompanied with symptoms of disorder of the heart,, 
intimated by palpitation, a pale, livid colour, and a very distressed state of re- 
spiration. The heart was found in its natural position, but the upper part of 
the right ventricle being pushed out so as to present somewhat of a sugar-loaf 
shape. The pulmonary artery was considerably contracted at its entrance into 
the heart, and destitute of valves. A finger introduced into the aorta entered 
freely into both ventricles. The left ventricle was natural, with the exception 
of a slight increase in the thickness of its parietes. The upper part of the 
septum between the ventricles was deficient, consequently the two ventricles 
communicated. The right ventricle was dilated, opposite the deficiency in the 
septum, into a pouch. The pulmonary artery communicated with a separate 
cavity, bounded by distinct walls, which, however, was attached to the right 
ventricle, and communicated with it by means of an opening capable of ad- 
mitting the little finger, formed under the columns carnese of the ventricle> 
The lining membrane of this cavity, as well as of the pulmonary artery, was 
spotted with lymph in several places, which, in the artery, assumed the appear- 
ance of warty excrescences. The two auricles were natural, except that the 
foramen ovale was open. The pulmonary artery was perfectly destitute of 
valves; at the usual situation of the valves it was a little puckered and contract- 
ed, above which the artery was considerably dilated, and it was in this dilated 
part that the warty excrescences were situated. 

The observations on the use of instruments, in cases of difficult and pro- 
tracted labour, by John Beatty, M. D, are extremely sensible and judicious > 
but contain nothing new to us on this side of the Atlantic. They are essen- 
tially the views promulgated by our learned collaborator, Professor Dewees, 
who by the by is quoted by the author; we will merely mention, therefore, 
that the object of the paper is to urge the utility of the forceps in certain cases, 
in which the perforator and crotchet has been too frequently resorted to. 

The memoir by John C. Ferguson, M. B. on auscultation as the only une- 
quivocal evidence of pregnancy, is extremely interesting and valuable. It is 
known to every one how important it sometimes is to determine whether a fe- 
male be pregnant or not, and how difficult and indeed impossible it is in some 



196 Bibliographical Notices. 

cases, to determine this during* the early periods of utero-gestation. An Italian 
physician has lately announced that pregnancy may always be known by the 
occurrence of a peculiar pain in the organ of amativeness. In our Periscope 
will be found a more particular notice of this symptom, the existence of which 
still requires confirmation. The signs of pregnancy afforded by the stetho- 
scope, and which were first observed, as most of our readers know, by a ta- 
lented young Frenchman, M. Kergaradec, consist in the bruit placentaire and 
the pulsations of the foetal heart. These are not usually observed before the 
fifth month, "but after that period, an accurate observer," Mr. Ferguson says, 
will seldom fail to detect either, and in most cases both. 

"The placentary noise," says Dr. F., "should be sought for in either iliac 
region, where, at least according to my experience, it will be most generally 
found. Yet have I detected it in almost every part of the abdomen; nor does it 
ever vary from the place where first heard. 

" The only error that I am aware of, into which we are liable to fall in making 
this examination, is, where the pulsations of the iliac arteries are accompanied 
with a bruit de soufflet. This, of course, is well calculated to deceive; but 
when the artery is the source of the bruit, we shall hear it, I am inclined to 
think, equally on both sides, at least I never met a case where this did not hold. 
Besides, it will not be heard save in the groin, whereas the noise of the pla- 
centa is heard over a space of some extent, perhaps three or four inches 
square. 

" The foetal heart I have heard in almost every region of the abdomen. Al- 
though it and the placenta are sometimes heard in the same side, and I have 
even found them in the same spot, yet have I observed that they were to be 
met with in the majority of cases, at opposite sides, generally in the iliac re- 
gion; so that this is the situation which I always examine first, and have rarely 
occasion to shift the instrument to any extent before either one sound or the 
other is discovered. The foetal heart, however, unlike the placenta, is not al- 
ways heard in the same place in the same individual; that is, it may be found 
to-day in one point, and in another to-morrow; though I have never found it to 
vary much from the point where first heard. Its double beat is well-marked; 
and the frequency of its pulsations is, I believe, always much greater, often 
double that of the mother's." 

Several very interesting and striking cases are related by Mr. F. in which he 
was enabled to detect pregnancy by auscultation, where the female stoutly de- 
nied being pregnant, and where no other evidence than that afforded by the 
stethoscope could be obtained. We cannot afford space to insert these, but we 
regret this the less, as the whole memoir will be found in the volume of Se- 
lect Medico-Chirurgical Transactions, which will be shortly published by 
Messrs. Carey and Hart. 

The two succeeding articles are by Dr. Robert Law. One is on putrefac- 
tive disorganization of the lungs, and the other on hsematemesis dependant 
upon disease of the liver. In the former, the author endeavours to distinguish 
between gangrene and that diseased condition of the lungs, to which modern 
pathologists have applied the designation of gangrene, a degree of refinement, 
apparently of no great importance. The essential character of the disease, 
Dr. L. considers to consist in slough and decomposition of the proper pulmo- 
nary tissue; four well-characterized cases of the disease are given, one or two of 
which we shall insert in our Periscope. 



Dublin Medical Transactions. 197 

The diseased condition of the liver productive of hsematemesis, consists, accord- 
ing to Dr. Law, 

" In an entire change of the proper substance of the organ, into a dense 
nbro-cellular tissue, forming a kind of pulp or parenchyma, in which the round- 
ish bodies, (which, projecting on the surface, give the organ its irregular ap- 
pearance,) are imbedded, its specific weight is greater than natural, while its 
actual size is less, and, so far from passing the margin of the ribs, it seems to 
have receded within its ordinary bounds, showing how fallible a criterion of the 
health of the organ is either its size orits descent below the ribs; its form is alter- 
ed; it becomes more round; its anterior margin more obtuse; its division into 
lobes less defined; its peritoneal covering thicker and more opaque than na- 
tural; its section exhibits no trace of blood-vessels, which we may presume to 
be either compressed or obliterated by the altered structure. Hence the im- 
pediment to the vena porta pouring its blood into its ordinary channels, and the 
influence of the obstruction reverts upon all the branches which concur to 
form this vein, and thus we do satisfactorily account for the haemorrhage." 

This pathological condition of the liver, is most frequently met with in per- 
sons who have indulged freely in the use of ardent spirits. Dr. Law inquires 
whether, as the direct tendency of such indulgence is to produce a chronic in- 
flammation of the gastro-intestinal mucous membrane, it would be pushing con- 
jecture too far to suppose the affection of the liver to be owing to the exten- 
sion of inflammation, from the intestine along the ductus communis choledo- 
chus? Such an opinion appears to us to rest upon something more solid than 
mere conjecture, and certainly has no novelty. 

Two cases of the disease are related, one of which will be found in our Pe- 
riscope. 

The case of cancer of the uterus and adjacent parts, by John Beattt, M. D. 
does not strike us as possessing any remarkable interest. There is some inte- 
rest, however, in the following remark. Dr. Beatty says, that in almost every 
instance in which he has been consulted for cancer of the uterus, the disease 
has arisen in persons in whom an early interruption of connubial intercourse 
had taken place, and that acting in reference to this observation, he has suc- 
ceeded in checking the disease in one case, by recommending a restoration 
of conjugal rights. 

We pass over an account of " a singular case of extra uterine pregnancy, 
by Robert Collins, M. D.;" and the " case of hydrophobia, by J. H. Purdon, 
Jun. M. D." as of no practical value. 

The ovarian disease of a remarkable character, an account of which, by W. 
F. Montgomery, A. M., M. B. follows, consisted of a tumour 

" Composed of fine membranes, dividing it into innumerable cells, which, 
with their fluid and transparent contents, resembled, at first sight, hydatids; 
the membranous septa dividing the cells were supplied with blood-vessels of a 
considerable size, running along their edges, so that the whole tumour pre- 
sented a clear reel colour. At its upper and left part, there was a deep cleft 
or fissure, into which the open hand might be passed without any force, and 
when carried downwards, and towards the right side, it entered a round sac 
equal in size, and much resembling a large flat turnip; this was the right ovary 
which lay just under, and was filled with the same structure as the part of the 
tumour first brought into view. In fact, it seemed as if the peculiar structure 
had at first grown in the ovary, which thereby became greatly enlarged, until 
at length the coat of the ovary had given way, and out of the fissure so formed, 
the morbid growth continued to enlarge, turning over the edges of the fissure, 
No. XV.— May, 1831. 18 



1 98 Bibliographical Notices. 

and covering the front and sides of the ovary in which it had formerly been con^ 
tained, so that the tumour was in a great measure turned inside out." 

The tumour was twelve inches long and nine broad. 

A fact of practical importance, and one which, though long since noticed by 
Morgagni and Van Swieten, and since urged by the Physiological School, by 
Dr. Abercrombie, &c. is, that in this case, at least two pints of pus were found 
in the abdomen, evincing a very considerable inflammatory action to have taken 
place, without its existence being indicated, either by pain or the character of the 
pulse. 

We have given in our sixth volume, page 224, a fatal case of scirrhus of the 
pylorus and ulceration of the stomach, in which no pain was at any time expe- 
rienced even on pressure, and many other cases to the same purport might be 
adduced, were it necessary, to show that abdominal inflammation may exist 
even in its destructive form, without its existence being indicated either by pain 
or the state of the pulse. 

The " case of anomalous labour, " by Dr. Thomas Ferguson, which follows, 
is curious and somewhat interesting. Dr. F. was sent for to deliver a woman 
who had been in labour for eighteen hours. On his arrival he found the 
feet of a child protruding almost without the os externum? the toes pointing to 
the perinseum, the os uteri fully dilated, and the soft parts in an advantageous 
state to facilitate delivery. 

"On further examination," says Dr. F. "I discovered that there were twins, 
and to my great embarrassment ascertained that the head of a second child had 
entered the pelvis, while by passing my finger along the spine and neck of the 
child then partly delivered, I could distinctly trace its head still remaining 
above the brim of the pelvis. My first efforts were to endeavour to push up 
the head of the second child then descending, so as to allow the other head, 
that of the first child, to occupy its proper place. But all my exertions proved 
ineffectual, owing to the powerful contractions of the uterus, which had been 
much facilitated in pressing the second head into the pelvis by the removal of 
the obstruction, which it before met in the arms of the first child; indeed, it 
would appear that this obstruction had retarded the descent of the second head 
at a much earlier period of the labour." 

Finding no possibility of extracting the little sufferer from his then perilous 
situation, Dr. F. resolved to have recourse to the perforator, but not having 
the instrument, considerable delay was occasioned, during which time nature 
accomplished the delivery. The second child, (a female,) in which the head 
presented, was born alive; the first, in which the feet had presented, and which 
was a male child, was born dead. The process of parturition was as follows: — 

" The descent of the footling was in the most favourable position for de- 
livery, the toes pointing to the sacrum, and must have been progressing in that 
regular course, until interrupted by the intrusion of the second head into the 
pelvis, so soon as the arms and shoulders of the first had fairly cleared its brim. 
Here then the second head must have made its way into the pelvis; its right ear 
to the sacrum, its left to the pubes. At this time the neck of the first child 
occupied the left angle of the pelvis, posterior to the head of the second, the 
head resting on the brim of the pelvis, ready to follow the descent of its com- 
panion; its left ear turned to the pubes, the right to the sacrum. In the labour 
process, the head of the male child became imbedded in the hollow of the neck 
of the female, its left ear occupying a situation nearly approaching the right 



Dublin Medical Transactions. 199 

ear of the female, but a litter higher up. The frontal bone of the female must 
have rested on the clavicle and shoulder of the male child, as was quite evident 
from the effects of the uterine action; for in proportion as the heacl of the fe- 
male advanced, so did the arms and shoulders of the male clear the os ex- 
ternum. 

" The face of the female when entirely protruded was turned upwards, the 
mother then lying on the left side. At this time the male head remained within 
the vagina, and it was only during the violent pains, which protruded the 
shoulders of the female, that the head of the male fell out on its face in the bed. 
The delivery was soon completed by the natural expulsion of the secundines." 

The next article is on the motions and sounds of the heart, and is by Dr. J. 
Corrigan, M. D. The views of the author in this paper have given rise to 
much controversy, and we think that they have been entirely controverted by 
a writer in some of the recent numbers of the London Medical Gazette. As 
the subject is one of interest, and the discussion appears to have elicited some 
interesting facts, we shall probably devote a distinct article to the subject. 

The case of ossification of the mitral and aortic valves, with induration of the 
tricuspid, hypertrophy and dilation of both auricles, by Patrick Clintojt, M.D. 
Is an interesting contribution to the pathology of the central organ of the circu- 
lation, and we shall insert it in our Periscope. 

The succeeding article is on polypi of the heart, as an idiopathic affection, 
and as a cause of death, by William Harty, M. D. The object of this paper 
is to prove that idiopathic polypus of the heart really sometimes occurs, and that 
its existence maybe ascertained during life by certain pathognomonic symptoms, 
contrary to the opinion of Allan Burns, and several other eminent pathologists. 

Two cases are related; in the first, a girl of fourteen years of age, 

" A distinct polypus of a whitish colour, unconnected with any coagulum, 
nearly filled the right ventricle and auricle, its branches extending into the 
great vessels, one branch being more than eight inches in length; the whole 
polypus adhered so slightly, as to be readily drawn out by the fingers; but a 
thick membranous substance of the same colour adhered with much firmness 
to the external side of the ventricle, penetrating into its interstices, and by 
means of both membrane and polypus, the valves were bound down, and must 
have been altogether impeded in their action — both auricle and ventricle were 
of a vivid colour, and of an inflammatory aspect. The left ventricle and aorta, 
however, presented a far more singular phenomenon. The ventricle was di- 
vided into two nearly equal cavities, by an adventitious whitish membrane, 
firmly adhering to the internal apex, and to the sides of the ventricle in a line 
nearly parallel to the septum, and terminating, as it approached the aorta, in a 
rounded organized polypus, tapering to a point, and entering above an inch 
into the aorta, which communicated very obliquely with the ventricle — the two 
cavities into which the ventricle was thus divided, communicated with each 
other very partially, where the membrane terminated in the rounded polypous 
concretion. The side of the membrane towards the left auricle was uneven; 
towards the aorta smooth. That auricle had the same inflammatory appear- 
ance as the right, and its valves were impeded by membranous layers, as those 
of the aorta were by the polypus — three of the carnese columns were much 
enlarged; one of them being more than twice the size of a goose quill." 

In the second case, that of a boy aged thirteen, the left ventricle and auricle 
contained 

"A large and singular polypus, unconnected with any coagulum, and ad- 
hering firmly in some parts, and more loosely in others. In the auricle, (pro- 



200 Bibliographical Notices. 

perly so called,) it adhered firmly throughout, maintaining a perfect uniot! 
therewith by a number of lateral projections, and thence descending into the 
ventricle by a long and narrow neck, it formed a flat and firm adhesion to the 
side of the ventricle, throwing out at the same time a band, whereby it was con- 
nected to the polypous concretion which loosely occupied the apex and body of 
the ventricle, and extended thence into the aorta. The body of the auricular 
polypus branched largely into the pulmonary veins, and in its thickest portion 
contained a distinct, dense, and compact clot of blood, enveloped therein." 

The symptoms in both patients, were palpitation, hurried respiration, 
pain about the region of the heart, epigastric tenderness, quick and strong 
pulse; with cough and temporary difficulty of lying on the left side. The 
symptom, however, which seemed peculiai'ly to characterize the disease, and 
which Dr. H. considers as the great diagnostic sign of polypus in the heart, or 
at least of its left ventricle, is a " singular thrilling, whizzing sensation, which 
every artery in the body, as well as the heart," imparts to the touch. 

The eighteenth article is the " Medical Report of the House of Recovery 
and Fever Hospital, Cork-street, Dublin, for the year 1829, by John O'Brien, 
M. D." In this institution, within the last 26 years,' 81,418 patients have been 
admitted, of whom 5,085 died. Notwithstanding the almost unparalleled op- 
portunities which have thus been afforded for pathological research, our rea- 
ders will not be surprised to learn, that the report throws no new light on the 
nature of fever, when we inform them, that by a most extraordinary, we might 
almost say criminal, regulation, dissections are prohibited in the hospital — a 
regulation, which by preventing the medical officers from improving their 
knowledge of the nature and treatment of fever, and thus lessening its mor- 
tality, contravenes the very objects for which the hospital was instituted — the 
cure of that disease—and deprives the world at large of the advantages which 
flow from all improvements in the healing art. The report of Dr. O'B. is not, 
however, devoid of interest; but we regret to find him urging arguments 
against the utility of post mortem examinations, as throwing any light upon fe- 
ver — and attacking mediate auscultation as a means of diagnosis. Such attacks 
always recoil upon the authors. The profession at the present day, are not to 
be blinded to the value of dissections or of the stethoscope; and when a writer 
underrates them, it leads to the suspicion that he is unwilling to assume the la- 
bour of the former, or lacks the industry requisite to learn the use of the latter, 
and desires that others should not be better informed than himself. Far be it 
from us to insinuate, that such a suspicion would be just, as regards Dr. O'B. 
but his remarks on these two subjects are at least unworthy an enlightened 
physician. 

The last article is a description of a very remarkable malformation in a foetus, 
by W. F. Montgomery. The most striking deviation from the natural 
structure, consisted in nearly all the abdominal viscera and the intestinal canal 
being external to the integuments of the abdomen. 



XVII. Therapeutique de la Phthisie Pulmonaire, suivie de notes — lo. Sur la Me- 
thode de Dzondi, et le traitment de la Syphilis et general; 2o. Sur le traitment 
du Typhus. Par A. Harel Du Tancrei.. Paris, 1830. 8vo. pp. 107. 
The author of the dissertation upon consumption lays no claim to the disco- 
very of a specific or nostrum, nor does he vaunt his liverwort or pulmel, or 



Tancrel on Phthisis Pulmonalis. 201 

other deceitful lure. "Is it," says he, "that a new specific has been at last 
found for this disease, or the secrets of its cure discovered ? Not that I know or 
believe. With the exception of those vended in bottles, I am acquainted 
with but one other secret in medicine, namely, the skill and tact of the phy- 
sician." 

Not satisfied with any of the attempts made by Broussais, Andral, and others 
to explain the formation of tubercles, he chooses to be silent upon the subject 
and confines himself mainly to the question of the curability or incurability of 
phthisis pulmonalis. The curability he maintains under the following condi- 
tions: First, when the progress of disorganization is arrested, before the pulmo- 
nary organ has become so far destroyed as to be incapable of performing its 
functions: Secondly, the existence in the system of a degree of organism ca- 
pable of supplying a certain amount of energy or of vital reaction: Thirdly, a 
medical treatment specially adapted to each individual, of sufficient energy to 
arrest the progress of disorganization in the pulmonary organ, together with 
the general consumptive tendency prevailing in the system. The success of 
this treatment depends upon the tact of the physician, since if employed with- 
out method or skill, it will most probably prove unsuccessful. 

The main therapeutic agents which our author depends upon, are the hydro- 
cyanic acid, used in the manner directed by Magendie, and especially the digi- 
talis purpurea and aconitum napellus, together with a combination of this last 
with the sulphuret of lime. One or more of these remedies are to be employed 
with those necessary precautions and attentions to minute details so strenuously 
insisted on by the venerable Hoffman. Without such attentions he makes no 
more account of these than of other agents that have been recommended in 
the same disease. 

The authority of our author in favour of the hydrocyanic acid is entitled to 
no great weight, however, inasmuch as he cites but a single case wherein its use 
was attended with salutary effects. He prefers the digitalis as much more 
manageable, and thinks that the prussic acid cannot be employed too cautiously, 
seeing that the indications of its actions are so very obscure. Of the three 
modes of administering digitalis, namely, in powder, tincture, and infusion, he 
thinks the last much the most energetic, after which he rates the tincture, and 
last of all the powder. 

"When," says he, " phthisis pulmonalis appears in a subacute form, and the 
febrile reaction running very high, carries the disease with giant strides to a fa- 
tal termination, it is necessary to adopt a treatment of corresponding energy, 
the effects of which will not be long in showing themselves. It is under these 
circumstances that it becomes necessary to give the preference to the infusion. 
In cases, where on the contrary the reaction is less active and of a more feeble 
character, the method of Neumann is not adapted to the condition of the organ- 
ism, and may be attended with the same dangerous effects as the hydrocyanic 
acid. In such cases, I always prefer the powder either alone or combined with 
the extract of aconite. The tincture of digitalis holds a rank intermediate be- 
tween those cases where the infusion and powder are demanded. I agree with 
Dr. Stoess in thinking it sometimes advantageous to combine the tincture of 
digitalis with the extract of aconite in the proportion of one drachm of the ex- 
tract to half an ounce of the tincture. It must not be forgotten that digitalis in 
all its preparations is a remed}' of great energy, the action of which must be su- 
perintended closely, for which purpose the patient should be seen daily. The 
indications of its operation do not always correspond with its intensity." 

18* 



202 Bibliographical Notices. 

In the extract just given from our author, allusion was made to the method 
of Neumann.* This consists in an infusion made by adding six ounces of water 
to half a drachm of the leaves of digitalis, several spoonfuls of which are to be 
given in the course of the day until indications are observed of the peculiar ope- 
ration of the medicine, such as slight nausea, giddiness, a sensation of contrac- 
tion in the throat, reduction of pulse, &c. In this case the use of the infusion 
must be suspended for eight days, this interval being necessary according to 
Neumann, attested by our author's observation, to a complete developement of 
the effects of digitalis. Our author asserts that he has seen, in the civil hospi- 
tal at Strasbourg, a most violent paroxysm of St. Vitus's dance arrested in the 
course of twenty-four hours by means of the infusion. 

We cannot well see upon what principle an article is exhibited in phthisis, 
the effects of which, namely, increase of the frequency of the pulse and cutaneous 
transpiration, irritation and even inflammation of the digestive organs, indicate 
it to be a most decided irritant. The medicine which occasions our embarrass- 
ment is aconite, which our author vaunts as a precious therapeutic agent, very 
capable of supplying the place of digitalis, when there is reason to believe this 
last of doubtful efficacy. In opposition to those who have pronounced the aco- 
nitum napellus one of the most redoubtable articles in the materia medica, our 
author asserts that it acts very mildly and almost insensibly upon the organism, 
and may be increased to a considerable dose without inconvenience, which cir- 
cumstance renders it much more safe than digitalis, and obviates the necessity 
of watching its effects so closely. He recommends it under the form of pills, 
composed of equal parts of the powder and extract of aconite, with half a part 
of the sulphate of lime, but has not mentioned the precise dose. He thinks 
these pills well adapted to complete the cure after a long use of the digitalis, 
when it would be improper to continue this last any longer. The sulphate of 
lime when given with the aconite, should be recently prepared, and the pills 
preserved in a vial perfectly dry and air proof. These pills, he says, possess 
the advantage of never disturbing the gastric functions. 

He considers it of primary importance to watch with particular care over the 
function of assimilation, and thinks that a milk diet, though very good when 
properly digested, is nevertheless often abused. He recommends light broths, 
preparations of sago and tapioca, and after the abatement of the febrile symp- 
toms the use of white meats and bouillons prepared with veal, frogs and snails. 
He speaks in favour of Iceland moss jelly, prepared with an ounce of the moss 
to two pints of water, which is to be reduced by simmering to one-half, and 
strained and sweetened for use — a table spoonful to be taken occasionally. To 
avoid too much bitterness, the product of the first infusion should be thrown 
away. 

As to Dzondi's method of treating syphilis, which is made the subject of a 
note subjoined to this treatise, it is founded upon the old opinion of a specific 
virus and a specific remedy. This subject has been so often reviewed in. this 
Journal that we feel little disposition to enter again upon its consideration. 
The method of Dzondi will be found moreover detailed in the first volume of 
this Journal, and in the same volume, and in Vol. VI. the subject of the speci- 
fic nature of syphilis and its specific remedy will be found amply discussed. 

G. E 
* Published in 1825, in a German Journal. 



Manual of Physiological Anatomy. 203 



XVIII. Manuale di Anatomia Fisiologica del Dottore Ltjigi Rolando, Professore dt 
JLnatomia nella R. Universita di Torino, Concigliere Straordinario del Magistrate? 
del Protomedicato, &c. &c. Tradotta ed Arrichita di molte Annotazioni dal 
Dottore in Medicina, Giovanni Meloni Baile. Volume Unico-Milans, 1829, 
pp. 338. 

Manual of Physiological Anatomy. Translated from the original Latin of Pro- 
fessor Ltjigi Rolando, by Giovanni Meloni Baile, M. D. &c. 

The work which we have announced above, was published several years 
ago in the Latin language, but had become so scarce, that the translator of the 
present edition was induced, with the approbation of the author, to prepare 
an Italian version of it, to which he has added a considerable number of notes, 
drawn for the most part, from modern researches. To Haller must be awarded 
the merit .of having first given an impulse to the study of physiological anatomy 5 
a subject which was subsequently so much enriched by the labours and disco- 
veries of Bichat, and which has, in modern times, imposed an entirely new as- 
pect upon the face of medical science. Anatomy and physiology are indisso- 
lubly connected with each other, and to render either contributive to useful 
and important purposes, they must be taken together. To arrive at a know- 
ledge of the functions of the organization, a knowledge of its structure is in- 
dispensable ; and the mere consideration of the configuration and relations of 
the organs, without a reference to their offices, would be an employment alto- 
gether insipid and void of utility. It is only by pursuing the course first 
adopted with success by Haller, and so advantageously pursued by nearly all 
physiologists since his time, of preceding the consideration of the functions, 
with some account of the structure of the organs by which they are performed^ 
that we can expect to arrive at truth, and secure the establishment of correct prin- 
ciples. This has been done with considerable ability by Professor Rolando, in 
the work before us, in which we have numerous indications of that strength 
and clearness of mind which is so fully manifested in his other publications. 
He commences with a brief exposition of the properties of the several structures 
which compose the organization. These, according to the author, are, 1, the cel- 
lular, which forms all the others; 2, the medullary substance of the brain; 3, 
the cineritious, or cortical substance of the same organ; 4, the muscular; 5, 
the tendinous, ligamentous, and aponeurotic; 6, the cartilaginous; and 7, the 
osseous. These, under various modifications, form other arrangements, which 
are more perfect, among which we may mention the vascular and nervous, 
which are designated by the author. He next enters into the consideration of 
the systems or apparatuses, commencing first with the vascular, including the 
heart. The description of each organ, or apparatus, is followed by an exposi- 
tion of its functions or uses; and in reasoning upon these, reference is always 
had to the characters of the structure. The rudiments of the vascular system 
are said by Professor Rolando, to exist in the ovum in form of a peculiar spongy 
lamina, even before conception. The cicatricula of an egg t according to his 
researches, is composed of the following parts: — 1, a peculiarly delicate 
epidermis, which envelopes the whole of the yolk; 2, a small vesicle, which is 
the rudiment of the amnion, and which subsequently forms the integuments of 
the animal; 3, a rounded spongy membrane, which, as the development pro- 



204 Bibliographical Notices. 

gresses, forms the entire vascular system; and 4, the saccus vittelinus of Haller, 
which constitutes the amorphous rudiment of the alimentary canal. Upon the 
spongy membrane which forms the vascular system, become ingrafted the first 
traces of the nervous system, after the cicatricula become fecundated by 
the semen of the male. These parts soon become more conspicuous; vessels 
gradually make their appearance, and are at first seen communicating freely 
with each other. From these, arteries and veins are given off, which, influenced 
by the rudimentary nervous system, finally form the left auricle and ventricle 
of the heart, which are developed before the right cavities of that organ. 
While these changes are taking place in the spongy membrane, the intestines 
are formed by the saccus vittelinus. These sentiments are at variance with 
those of Malpighi and Haller, who, our author affirms, fell into the additional 
error of confounding the ganglions of the great sympathetic nerve with the 
rudiments of the vertebra. 

But to return to the work under consideration, we have only to state, that 
though the descriptions are brief, they are generally sufficiently minute to pre- 
pare the student for the just appreciation of the functions, and that they are 
drawn up with clearness and accuracy. As the principal object of the author 
was merely to supply students with the general principles of physiological 
anatomy, he has refrained from entering into any minute details, and in doing 
so, he has furnished the junior part of the profession with a work, from which 
we have no hesitation in saying, they will derive much valuable instruction. 

E. G. 



XIX. Anthropogenese ou Generation de V Homme, avec des vues de Comparaison 
sur les Reproductions des trois regnes de la Nature, et des Recherches sur la Con- 
servation des Especes et des Races, les ressemblances sexuelles des autres, le 
Croisement des Races, les Causes de la Fecondite, de la St6riliti, de VEmpuis- 
sance et sur d'Autres Pkenomenes des Revivifications Naturelles. Par J. B. De- 
mangeon, M. D. &c. &c. Paris, 1829. pp. 346. 8vo. 

In investigating the intricate subject of generation, M. Demangeon has not been 
content with treating of its phenomena in man alone, but has extended his re- 
searches into the three kingdoms of nature, and from a comparison of different 
modes adopted by nature for the reproduction and perpetuation of her works, 
has endeavoured to establish a theory of generation founded on what takes 
place, instead of on assumed facts, and oftentimes extravagant assertions. He 
has not, however, been satisfied with this ample field, but has pursued the sub- 
ject in its relations with practical medicine and with jurisprudence. We do not 
think he has been altogether successful in this undertaking, though he has cer- 
tainly presented the world with a work abounding in new views, which may 
lead to ulterior investigations, and finally tend to establish this doubtful and 
contested subject on a settled and fixed basis. 

From the nature of the work it is impossible for us to do more at the present 
time than to lay before our readers an analysis of its contents, with some very 
cursory observations on a few of the topics he has discussed. The first chapter 
is on generation in those species in which there is a known difference of sex. 
The author here takes a rapid view of the reproductive process in the vegeta- 



Demangeon on Generation. 205 

hie and animal kingdoms, making- this distinction between them, " that sexuality 
is only a temporary phenomenon in vegetables, whilst in animals it is constant, 
forming- in fact a property of their organization." Dr. Demangeon appears to 
think that omne vivens ex ovo, though he acknowledges that this theory will not 
solve all the problems which arise from the subject of generation. Chapter se- 
cond is devoted to the consideration of generation in species in which the sex 
is unknown, or, in other words, of what has been termed equivocal generation, 
The author's ideas on this disputed point are very ingenious; he refuses any 
credit to a majority of the instances which have been adduced in proof of the 
truth of this doctrine, still he does admit that it may take place in certain im- 
perfectly organized bodies, as hydatids, confervae, &c. Chapter third treats of 
generation in intestinal worms. This is in truth a continuation of the preceding 
chapter, in which the author appears to be almost inclined to admit the fact of 
spontaneous generation among these animals. Chapter fourth is on the per- 
petuation of species, races, and resemblances by manifest sexual vivifications. 
These resemblances the author thinks that he has proved to depend on a rela- 
tive superiority of vigor, or in the more mature age of one or other of the pa- 
rents. This chapter is extremely interesting, and replete with curious facts, 
Chapter fifth, on the first synthesis and evolution of the embryon, is filled with 
hypotheses and conjectures, which are any thing but satisfactory; the author 
seems to have given his imagination full sway without reference to reason or 
facts. The next chapter, however, which is devoted to a brief exposition of 
the different theories of generation, contains much important matter. Chapter 
seventh, on the capacity for generation, and the product of the sexual secre- 
tion in males, with the hygienic causes of fecundity, in general affords many 
interesting data for the medico-jurist as well as for the physiologist. Chapter 
eighth treats of the product of the sexual secretion in females, and of their fe- 
cundation. This chapter is very unsatisfactory, and the author at last refers to 
Hippocrates, as giving the best account of the first formation of man. The ninth 
chapter, on sterility and impotence, is deserving of attention, on account of its 
medico-legal bearings. The author makes a clear distincticn between these 
two states, which have been too often confounded. " Fecundity in the female 
is her aptitude to become a mother, and in man, the aptitude of rendering a 
woman fruitful. The opposite state in either sex is sterility. " Impotence he 
defines as an impossibility of either sex to exercise the genital functions. These 
distinctions become extremely important as relates to questions of rape, divorce, 
legitimacy, &c. These states not only differ in their causes, but also in their 
bearings and curability. As regards hermaphrodism, which is the subject of 
the tenth chapter, the author is very decided in his opinion, that it never takes 
place in the human race, all the cases of alleged double sex being anomalous 
and monstrous productions, which, although presenting an appearance of an 
union of the male and female organs, were in reality but deformities, and that 
there never was an instance in which the double faculty of engendering and 
conceiving were concentred in the same individual. Dr. Demangeon cites a 
number of very extraordinary cases, which appear to be well authenticated, 
where the apparent union of the sexes was perfect, though strictly and physio- 
logically speaking, the unfortunate victim of them really appertained to one or 
the other. Chapter eleventh is on superfcetation, or where a foetus is conceived 



206 Bibliographical Notices. 

whilst the uterus is occupied by the product of a former impregnation. This 
subject, which has given rise to numerous and bitter controversies, is by no 
means placed on its proper basis even at the present day; our author seems 
willing to deny its possibility, referring all the cases to twins of the same con- 
ception, but born at different epochs; in this, however, his previous theories 
have blinded him to the multitude of well-authenticated cases, in which there 
can be no doubt of the reality of this process. That many of the cases which 
have been referred to superfcetation, were in fact cases of twins, must be ad- 
mitted, but we have also a host of instances in which such an explanation is 
impossible; some of these are given in the former numbers of this Journal. 
Neither can we refer them in every case to the existence of a bilobate 
uterus, though it is probable that this malformation occurs in a generality of 
them. Chapter twelfth, with which the work concludes, is devoted to the con- 
sideration of the term of gestation and its anomalies. This contains nothing 
new as respects the human species, notwithstanding the great importance of 
the subject, but the author has collected some interesting facts in relation to 
the variations to which it is liable among our domestic animals. R. E. G. 



XX. Darstellung blutiger heilkunstlerischer Operationen, als Leit faden zu seinen 
Jlcademischen Vbrlesungen und fur operirende Heilkunstler, bearbeitet. Von 
Christoph. Bonifacius Zang, der Chirurgie und Medicin Doctor, Sr. k. k» 
apost. Majest'at Rathe, ordentlichem offentlichem Lehrer der Chirurgie, &c. 
Ester band, Dritte Auflage, Wien, 1823. Zweyter Band, 1824. Dritter, 
vierter, und fiinfter Band, 1818-19-21. Mit kupfertafeln, &c. 

Treatise on Surgical Operations, designed as a text book for the author's Academi- 
cal Lectures, &c. By Christopher Boniface Zang, Doct. of Surgery and 
Medicine, &c. 5 vols. Vienna, 1823-24. 

We have been much gratified with the perusal of this treatise on surgical 
operations, and regret that we shall be obliged, for the present, to confine our- 
selves to a mere annunciation of its contents. It has been so well received in 
Germany, that the two first volumes have already passed through three editions 
since 1812, the date of their first publication. 

The author commences with the consideration of the minor surgical opera- 
tions, C Petit Chirurgie of the French,) as scarifications, the application of cups 
and leeches, venesection, arteriotomy, &c. These different topics are treated 
with all necessary minuteness of detail; the indications which call for the seve- 
ral operations, the circumstances which render them improper; the necessary 
apparatus, the disposition of the assistants, the position of the patient, the se- 
veral arts of the operation, together with the after-treatment, being all parti- 
cularly considered. We have next, an exposition of the several operations for 
aneurism, and for securing wounded arteries. The rules to be observed in 
these operations, are laid down with much clearness and precision, and the 
plans recommended are, for the most part, those which comport best with 
the anatomy of the parts concerned. The remainder of the first volume is 
taken up in the description of the operations for varicose veins, opening of 
abscesses, the extirpation of tumours, the application of cauteries, extirpation 
of polypi, &c. 



On the use of Chloride of Soda and Lime. 207 

The second volume embraces the consideration of the several operations 
which are performed on the head and face, eyes, mouth, and ears. All these 
subjects are treated with ability, and while the author advances his own 
opinions, he treats those of others with becoming- candour and liberality. In 
the third, fourth, and fifth volumes, the operations which are performed on the 
neck, trunk, and extremities are considered, and throughout, the same clear- 
ness, the same methodical description and liberality towards the sentiments of 
others are evinced. Our limits will not admit of our selecting any particular 
portion of our author's labours, in exemplication of his manner, but we have no 
hesitation in affirming, that as a treatise on operative surgery, the work of Pro- 
fessor Zang is one of the most complete which has fallen under our observa- 
tion. The work of Schreger on that subject, though possessing much value, 
cannot be considered as any thing more than a mere synopsis. The more ela- 
borate treatise of Bierkowskie, though not liable to the same objection, is 
nevertheless defective in many important details. Its merits, too, are much in- 
debted to the work under notice, as many of the operative proceedings are 
taken from it. The work of Sabatier is antiquated, although many valuable 
additions have been made to it by Roche and Sanson. The English language 
contains no good work on the subject. We have, therefore, no hesitation in 
declaring it as our deliberate opinion, that at the present time, the treatise of 
Professor Zang is decidedly the best in any language, upon the subjects of 
which it treats. A work of the kind is a desideratum in the English language, 
and we think, that any one, who would undertake the task, might, by uniting 
the mathematical precision of Lisfranc, with the clear and systematic details 
of the German surgeons, produce a work on operative surgery, which would 
entitle him to the lasting gratitude of all cultivators of surgical science. 

E. G, 



XXI. Instructions and Observations concerning the use of the Chlorides of Soda and 
Lime. By A. G. Labarraclue, Member of the Hoyal Academy of Medicine of 
Paris. Translated by Jacob Porter, Member of the American Antiquarian 
and Geological Societies, &c. &c. New Haven, 1829, pp. 22, 8vo. 

Method of using the Chloride of Soda, either for Dressing Ill-conditioned Sores, or 
as a means of Purifying Unhealthy Places, and of Disinfecting Animal Sub- 
stances. By A. G. LABARRAQ.UE, &c. &c. Translated by Jacob Porter, &c. 
&c. New Haven, 1830, pp. 7. 

The credit of demonstrating, by a great number of experiments, the extra- 
ordinary disinfecting powers of the chloride of lime, is due to M. LABARRAauE, 
a distinguished Pharmaceutist of Paris, and it is to the facts developed by his 
experiments that we are also indebted for the application of the article to the 
cure of several diseased conditions of the body. 

In the memoir at the head of this notice, the method of employing the chlo- 
rides for the purpose of destroying offensive and infectious odours is minutely 
detailed, and the most striking evidence of the power of those preparations 
adduced. Bodies exhumed for medico-legal investigations, in an insupportably 
offensive condition, have been rendered so free from odour that an examination 
could be made with perfect safety and convenience. 



208 ■ Bibliographical Notices. 

Instead, however, of copying 1 the instructions given in the memoir alluded 
to, we shall give an extract from a report presented to the Council of Health 
in Paris, on the removal of the dead bodies that had been deposited in the 
vaults of St. Eustache after "the three days," by M. Labarraque, as it will not 
only exhibit the proper mode of procedure in similar cases, but afford evidence 
of the efficacy of the means resorted to on that occasion. 

In the church of St. Eustache, forty-three bodies were interred after "the 
three days" in July last, and they produced so offensive an odour, that they 
could not be suffered to remain without detriment to the health of the neigh- 
bourhood. The council of health, therefore, determined to have them re- 
moved, and entrusted the execution of the task to M. Labarraque. In the re- 
port of this gentleman to the council, he says — 

" A horrible smell filled the church, and a neighbouring house, into which it 
penetrated through a vent hole in a chimney funnel. Measures had been pro- 
posed to remedy this accident, but by some mismanagement in the proprietor 
of the house, the thing was made worse than it was before. It was intended 
by the Committee of the Council to establish, by means of a tube connected 
with the stack of chimneys, a rapid current of air, which would have most ma- 
terially facilitated the removal of the corpses; but this failing, recourse was had 
to the expedient of opening two entrances, by which to descend into the vaults. 
But what with the anticipated difficulty of procuring an effective body of work- 
men, and the other necessaries for the accomplishment of the design, besides 
the apprehension of not being able to finish it in a single night, so as to leave 
the church at liberty for the celebration of service on the great festival, it was 
determined to postpone the operation until the 16th of August, at ten at night; 
and till then nothing more was to be done, except the neutralizing of the pu- 
trid odour which was diffusing itself in the church through the floor of one of 
the chapels: here some chloruret was deposited, and with complete success. 

" When the appointed evening came, about half past eight, we placed, on 
either side of each intended opening, a trough of the capacity of about 
forty gallons, and a similar one at the great door of the church. Into one of the 
largest troughs, we threw about fourteen pounds of chloruret of lime, and 
upon it poured as much water as the vessel would contain. After suffering it 
to stand for half an hour, we decanted the liquor into the second large trough. 
More water was then poured upon the residue of the chloruret until it was ex- 
hausted, and finally a farther quantity of fourteen pounds more, with additional 
water, was poured in, until all the troughs were filled with the chloruretted fluid. 
Meantime, all the doors and windows of the church being thrown wide open, 
the operatives fell to work in effecting the new entrances into the vaults, and 
the moment the matlock penetrated the cavity, a copious affusion of the chlo- 
ruret was made, and with such effect that the workmen did not perceive the 
least disagreeable odour. The size of the openings when finished was about 
six feet by two, and through them a plentiful shower of fluid was discharged 
into the vaults. By this time M. Parton had arrived with suitable vehicles, two 
casks for containing chloruret, and twenty stout labourers, sewer-cleaners by 
trade. The work was now vigorously begun. Three men, one of them from 
the morgue, and all accustomed to the kind of work they were going to do, 
equipped themselves with a protecting cover, fen bridage,J and went down 
into the vaults with lighted lamps in their hands. Two buckets of chloruret 
had been previously let down, and the men scattered the disinfecting liquor 
copiously over the walls and floor of the vault. The bridage interfered mate- 
rially with the progress of their operations, and MM. Parent du Chatelat and 
M. Labarraque descended as well for the purpose of viewing the bodies and the 
state of the place, as to ascertain whether the workmen could safely strip off 



On the use of Chloride of Soda and Lime. 209 

their outer covering 1 , and pursue their labours divested of that cause of embar- 
rassment. 

" The vaults of St. Eustache are of great extent; they are in the form of a 
cross, the longer limb of which measures upwards of 65 feet by 24, and the 
roof is 16 feet high. The transverse part of the cross is much more narrow, 
the height of the roof, however is the same. In one of these parts lay twelve 
bodies, most of them of large size. Just beneath one of the openings was a 
heap of earth reaching nearly to the roof, and which obliged whoever went 
down to creep on all fours: it happened, too, that under a portion of this heap, 
three more bodies were placed, that gave great trouble in their removal. The 
remainder of the corpses were ranged side by side through the vaults, simply 
covered with a slight stratum of powdered lime, which retarded their disorgani- 
zation a little. A bed of lime thickly spread over the floor must necessarily 
have absorbed the carbonic acid, whence the reporter concludes that carbonic 
acid, at least in this instance, has not been the cause of the rapid disinfection of 
the air of the vaults, and that an exact theory of the phenomenon still remains 
to be discovered. 

" A number of thick, compact, and spongy pieces of linen cloth were pre- 
pared; they measured each of them two metres every way; they were steeped 
in the trough of chloruretted liquid, and after being slightly wrung out, were 
conveyed down into the vault. There the workmen used them one by one; 
each piece of cloth was laid alongside a corpse, and then the latter was drawn 
over upon it by means of a drag. Once on the cloth, the body by rolling 
was easily wrapt up in it. The envelope was then tied at head and foot with, 
packthread, besides with a stout cord which went round the body in three 
places; after which four of the men took it up and laid it beside the opening, 
where it was sprinkled with the fluid; and then five more men conveyed it 
to the carriage. On its passage to, and deposition in the vehicle, it was again 
bedewed with chloruret. During the whole of these operations the labourers, 
who relieved one another alternately, took care from time to time to bathe 
their hands in the disinfecting fluid, and to make such repeated sprinklings 
about the opening of the vault, that the atmosphere in that quarter was fully 
charged with the chloruretted vapours. The removal of the forty-three bodies 
was begun about a quarter past ten, and brought to a conclusion, without any 
accident, at half past one; and should have been finished sooner, but for the 
difficulty of getting at the three last corpses. About half the fluid was still re- 
maining, and was poured out on the floor of the vaults, in order to' remove the 
troughs the more readily. 

" But the deputies of the Council of Health did not deem their task yet com- 
pleted; one of them proceeded to the cemetery Montmartre, along with M. Bar- 
ton, and all the labourers who were employed in the work we have just 
detailed. The bodies were conveyed in seven carriages; an eighth carried 
the utensils, and was followed by two hogsheads of fluid, and a cart full of 
quicklime. The procession set out at two in the morning, and was conducted 
with all that respectful attention which is so sacred to the mourning soul. 

" A common grave, of eleven metres in length by about four and a half in 
breadth, and two in depth, had been laid out for them by order of the prefect 
of the Seine. In this the corpses were deposited, after having been once more 
well sprinkled with chloruretted liquor, which we prepared on the spot by the 
admixture of a pound of chloruret to six buckets of water. The men who laid 
the bodies in the grave were provided with this liquor, and those who were oc- 
cupied in unloading the carriages also made much use of it. In fine, the vic- 
tims, after having been decently settled, were covered with quicklime and then 
with earth." 

The disinfection was rapid and complete, and the removal unattended with 
danger. 

As a disinfecting agent the chlorides of lime and soda are indeed invaluable, 
No. XV.— May, 1831. 19 



210 Bibliographical Notices. 

but their utility is not restricted to such purpose, It has been successfully 
used in a gangrenous affection of the jaw, by Dr. Rey — in venereal ulcers by 
Dr. Goosse— in certain ulcers by M. Cullerier — in scald head by Dr. Roche — by 
M. Lisfranc in burns and common ulcers — by M. Bouley, fils, in gangrenous tu- 
mours—by Dr. Horner in a case of ozena — and by Messrs. Graves and Stokes in 
a case of pectoral disease with great fetor of breath and expectoration. It has 
been used also with great advantage by M. Biett in certain herpetic affections— by 
M. Jules Cloquet in gangrenous ulcers — by Professor Marjolin and Dr. Segalas in 
gangrenous affections — by MM. Sanson and Lagneau in ulcerations of the mouth 
and caries of the bone — by Dr. Cautourelle in two cases of malignant sore 
throat; and we have no doubt that it may be usefully employed in the gan- 
grenous sore mouth of children. We have employed it ourselves with advan- 
tage as a collyrium in purulent ophthalmia, and as an injection in gonorrhoea; and 
little doubt can be entertained that it may be beneficially resorted to in many 
other complaints. The powers of the remedy have, however, as yet not been 
fully investigated, nor its precise value determined in those diseases to the cure 
of which it has thus far been applied. 

It is not our object at present to enter into minute details, but rather to 
attract the attention of the profession to the substance, that its powers may be 
more satisfactorily ascertained: we will only add that it is usually employed in 
solution of various degrees of strength, and will refer the reader for further de- 
tails of its medical application, to the Periscope of our previous numbers, in 
which we have been careful to record, as they have been published, the results 
of the experiments that have been made with it. 



XXII. Nuovi Elementi di Jlnatomia, ad uso dtlle Scuole di Florxanq Caldani. 

Tom. primo e secundo, pp. 806. Bologna, 1827. 
Elements of Anatomy , for the use of students. By Floriano Caldant, 2 vols. 

Bologna, 1827. 

The work which we have here announced, is merely a translation of the 
Latin edition of the Institutiones Anatomicse of Leopold Caldani, the uncle of 
the present editor, which was published several years ago. The arrangement 
has, however, been considerably altered, and numerous additions have been 
made to bring it up with the present state of anatomical science. With regard 
to the execution of the work, it is needless we should say much. The descrip- 
tions are in general sufficiently clear, but in many parts we think the author 
has left his subject very far in the rear of the present improved state of anato- 
mical knowledge. In some respects, however, it must be confessed, that Pro- 
fessor Caldani has executed his task in a creditable manner, and as an elemen- 
tary treatise for students, for whose use it was expressly composed, it will 
doubtless be found useful. In conclusion, we should state, that the present 
work is by the author of the splendid, collection of anatomical plates, published 
under the title, Icones Anatomicse, quotquot sunt celebrioses, ex optimis 
neotericorum operibus summa diligentia depromptse et collects, Venetiis, 
1801-14, in fol. E. G, 



Elements of Pathological Anatomy. 211 



XXIII. Lehrbuch der Pathologischen Anatomie des Menschen und der Thiere. 
Von Dr. Adolph Wilhelm Otto. Koniglichem Medicinabrathe in Medicinal 
collegium fiir Schleisen, ordentlichem Professor der Medicin an der Univer- 
sitat und der Medicinischen Chirurgischen Lehranstalt zu Breslau, &c. &.c. 
Erster Band. pp. 472, Berlin, 1830. 

Elements of Pathological Anatomy of Mm and Animals. By Adolph Wilhelm 
Otto, M. D. &c. 1st vol. Berlin, 1830. 

Pathological anatomy has been, within the last twenty years, cultivated with 
great zeal and ability in Germany, and the medical literature of the country 
has, within that time, been enriched by numerous treatises on the subject, 
which have contributed powerfully to extend the boundary and augment the 
usefulness of the science. Amongst these may be enumerated the work, the 
title of which is affixed to this notice. Dr. Otto is a distinguished professor at 
Breslau, and has been for some time advantageously known, by the publication 
of several works of merit, and especially by his manual of Pathological Anatomy, 
which was printed in 1814. The present undertaking professes to be an entire 
new work, for the reason, as the author informs us, that since the period at 
which his manual was published, the principles of the science have become 
greatly changed, and his own opinions have undergone such an alteration, as 
to render a republication of the same work inexpedient. In the treatise before 
uSj the various lesions are referred to some derangement, either of quantity or 
quality, implicating the function of nutrition; or to a mechanical separation of 
the natural connexions of the organization. The structures, under either of 
these modifications, must, moreover, according to Dr. Otto, be considered in 
reference to their situation, volume, configuration, position, connexions, colour, 
consistence, continuity, texture, and the parts they contain. It will readily be 
seen, that under these several heads, may be veiy conveniently arranged every 
thing important, appertaining to pathological anatomy. This the author at- 
tempts by examining first the general properties of each of the conditions 
enumerated, after which he proceeds to consider them as developed in the 
several tissues which compose the organization. In the performance of this 
undertaking, he has not only carefully described the various lesions to which 
the several structures are liable, but has also enriched his work with an ex- 
ceedingly copious collection of references to cases and instances illustrative of 
the principles discussed, and to works which furnish valuable information en 
the subject. This portion of the work is the most extensive, and although 
valuable to the student, it is, we think, carried to an unnecessary degree of 
minuteness. Where we meet in a work with so copious a list of references, 
we are too apt to suspect that the author has taken many of them at second 
hand, and consequently that many of them cannot be relied upon. We would 
not be understood to apply this to Professor Otto; but merely to express it as 
our opinion, that his work would have been quite as useful without having 
such a formal display of references appended to it. But notwithstanding this 
defect, it gives us much pleasure to state, that we have been much pleased 
with the work, and we can confidently recommend the part which has been 
published, as containing much important information, E. G, 



212 Bibliographical Notices. 



XXIV. The Influence of Climate in the Prevention and Cure of Chronic Diseases, 
more particularly of the Chest and Digestive organs: comprising an account of 
the Principal Places resorted to by Invalids in England, the South of Europe, 
&c.; a Comparative Estimate of their Respective Merits in Particular Diseases, 
and General Directions for Invalids while Travelling and Residing Abroad. 
With an Appendix, containing a Series of Tables on Climate. By James Clark, 
M. D. Member of the Royal College of Physicians of London, Corresponding" 
Member of the Royal Medical Society of Marseilles, of the Medico-Chirur- 
gical Society of Naples, of the Medical and Physical Society of Florence, of 
the Academy of Sciences of Sienna, and Physician in Ordinary to his Royal 
Highness Prince Leopold of Saxe-Coburg. Second Edition, enlarged. Lon- 
don, 1830, pp. 400. 8vo. 

The first edition of this valuable work was reviewed in the fifth volume of 
this Journal, on which occasion we expressedthe favourable opinion entertained 
by us of its merits: we have now the pleasure of introducing to our readers a 
second edition, enriched by some very interesting additional information respect- 
ing the climate of certain parts of England, of the principal islands of the 
Northern Atlantic Ocean, and the West Indies. 

We hope that the author will in his next edition, which we are sure will be 
required, insert such facts as he may be able to collect respecting the climate 
of America. Such an addition would render his work more valuable abroad, 
and ensure it an extensive circulation in this country. 

Physicians who are sending patients to Europe for the benefit of change of 
climate, and invalids who cross the Atlantic for their health, will find in the 
work of Dr. Clark information that will be invaluable to them, and which they 
cannot obtain elsewhere. 



XXV. Elements of General Anatomy, or a description of every kind of organs 
composing the human body, by P. A. Beclard, Professor of Anatomy of the 
Faculty of Medicine of Paris. Preceded by a critical and biographical memoir 
of the life and writings of the author, by Ollivier, M. D. Translated from 
the French, with notes, by Joseph Togjto, M. D. member of the Philadelphia 
Medical Society, pp. 541. Philadelphia. Carey & Lea. 1830. 

We are pleased to find that our medical community are becoming daily con- 
vinced of the importance, and even the necessity of the study of general anato- 
my; and still more gratified at the increased facilities which are every day 
springing up, to aid the student in the acquisition of that knowledge which can 
alone place the principles of physiology and pathology, and with them every 
department of the science, upon a secure and useful foundation. Amongst 
these, we are happy to find an English version of the excellent treatise of Pro- 
fessor Beclard, on General Anatomy. The original work has been before the 
public since 1823, and constitutes one of our most valuable acquisitions to stores 
of medical literature, since the appearance of the work of the immortal Bichat. 
Indeed, the author of the present treatise may be justly considered as a kind of 
successor to the great man, whose name we have just mentioned. Emulating 



Physicians and Surgeons of Paris. 213 

his zeal, he ably trod in his footsteps. He early became engaged in similar 
pursuits, and by his great abilities, contributed to enrich the science with new 
and valuable accessions. Like Bichat he lived, and like him he died — ex- 
tending on the one hand the bounds of the science, and enriching its domain, 
and on the other cut off in the midst of his usefulness; but not until he had 
done enough to convince us that his loss was irreparable. - Like him, too, he 
composed one of the most important works which has ever appeared on the 
subject of anatomy. This, then, is the man, and this the source of the work, 
for the translation of which we are indebted to Dr. Togno. In conclusion, we 
will only observe, that the translation, though not characterized by elegance 
of diction, for the most part accurately represents the meaning of the au- 
thor. "We repeat, that the work of Professor Beclard is one of the most 
valuable we possess on general anatomy, and that no physician or student should 
be without it on his shelves or in his studv- E. G. 



XXVI. Sketches of the Character and Writings of Eminent Living Surgeons 
and Physicians of Paris. Translated from the French of J. L. H. P. by 
Elisha Bartlett, M. D. Boston, 1831. 

This is said to be the production of a young advocate of Paris, and if this be 
the fact, the extensive and minute acquaintance which the author displays 
of the character and writings of the men who figure in the medical world of 
Paris is truly extraordinary. His sketches of their characters are exceedingly 
spirited and graphic — and his criticisms of their writings are mostly just, always 
lively, and frequently very piquant. It is indeed one of the most entertaining 
little books that we have met with for a long time, and at the same time very 
instructive, and Dr. Bartlett has conferred a benefit on the profession in trans- 
lating it. We cannot refuse ourselves the pleasure of quoting the following just 
remarks from the translator's preface. 

He states that one of the objects of the publication is to awaken in the 
younger members of the medical body, by the influence of high examples, a 
more devoted and worthy emulation of the great masters of our art; and then 
adds: — 

" The contemplation of this exalted excellence in others may show us more 
clearly our own deficiencies, and arouse us to the efforts necessary to supply 
them. After making all reasonable allowance for natural tact or talent, and for 
the facilities and advantages of instruction to be had in extensive medical esta- 
blishments, it will be found that study, intense, untiring, unremitted study, is 
the only foundation of professional worth and distinction. Has not medical 
science in our own country felt, in some degree, the withering influence of the 
superficial literature of the age? Let us look at Dupuytren, the unrivalled chief 
of modern surgery, holding, while a boy, offices which were the reward only 
of solid scientific knowledge; at Beclard; at Bichat, who, dying at the age of 
thirty-one, left behind him a reputation second only to that of John Hunter. 
These men have imprinted, deeply and indelibly, the traces of their labours on 
medical science, and the history of their lives may teach us that similar honours 
can be won only by similar means." 

The following observations, by the author, on eclectism, are worthy of con- 
sideration: — 

"Some men, especially at the present day, have taken refuge in an eclectic 
system, Ceclectisme;J but they cannot maintain themselves in this. In effect, 

19* 



214 Bibliographical Notices. 

eclectism is sheer nonsense in medicine. This word signifies to choose among 
the most reasonable systems, or to adopt the most rational portions of each 
system, and the best methods of treatment. Behold the practitioner well ad- 
vanced, to be sure ! How shall he choose, and how estimate the value of his 
choice? By reasoning. Yes, let him reason on this immense number of facts 
of every species; let him read twenty thousand volumes; let him discuss the 
whole, according to the laws of medical and historical criticism; and then, let 
him indicate, d priori, what things it is necessary to believe and to do, and he 
will find himself the inventor of the newest, and certainly the most extravagant 
system in the world. But he will be governed by experience! The experience 
of whom ? He has only his own, for that of all past time and of the present 
must be controlled, for herein consists the Very essence of ecledism. The prac- 
titioner is thus reduced to his own personal experience, and to the necessity of 
recommencing the labour of centuries, which have taught him nothing. This 
is not indeed true of all branches of medicine. I know that the experience of 
centuries has left, floating above the ruins of systems, some rules of practice 
generally admitted in all places and in all times; but they are few in number, 
and reduce themselves rather to the principles of hygiene than of cure; and 
they may be found in Hippocrates, who discovered them, because he was one 
of the best observers, and the first. But this does not constitute a science." 

We have already reviewed the original in a preceding number of this Jour- 
nal, and of course shall not go again over the same ground; our object is merely 
to call the attention of the profession to the translation, from the perusal of 
which we can promise the reader both entertainment and instruction. 



XX VII. Encyclop'ddischesWoterbuch der Medicinischen Wissenschaften herausgege- 
ben von den Professor en der Medicinischen Facultat Zu Berlin: D. W. H.Busch, 
C. F. v. Graffe, C W. Hufeeand, H. F. Link, K. A. Rudolphi. Fumfler 
Band. (Bandage— blutfluss. ) Berlin, 1830. 

We are highly gratified with the ability manifested by the Professors of the 
University of Berlin, and their talented contributors, in conducting the Medical 
Encyclopaedia, to which we have already several times called the attention of 
our readers. We have received the fifth volume, as announced above, and feel 
assured, from a hasty examination of its contents, that it merits all the praise 
bestowed upon those which have preceded it. Many of the articles are elabo- 
rate, and evince much taste, ability, and research on the part of the writers; 
most of them are creditable, and we think we do not say too much, when we 
affirm, that the entire work, as far as it has yet progressed, may safely challenge 
a comparison with any similar publication. On some more convenient occasion 
we propose to furnish our readers with an analysis of some of the leading ar- 
ticles. In the mean time, we confidently assure the distinguished editors, that 
the remaining part of the work will be awaited with anxiety, and hailed with 
pleasure, by every zealous cultivator of German medical literature on this side 
the Atlantic. E. G. 



( 215 ) 



QUARTERLY PERISCOPE, 



FOREIGN INTELLIGENCE. 



ANATOMY. 

1. Malformation of the Eyes. — Professor Marse, of Brunswick, relates in 
Schweigger's Journal, the case of a girl, aged twenty-one, in whose eyes the 
lens is situated immediately behind the cornea; the iris is closed, but is very 
thin, and is pushed backwards so as to be almost funnel-shaped. The lens and 
iris are both completely transparent, so that the choroid may be seen through 
them. The individual could, until lately, see very well, except in a strong 
light; and it was not until cataract began to form in the right eye that the sin- 
gular position of the lens was observed. The eyelids are remarkably thin and 
wrinkled, and appear almost to indicate a tendency of nature to compensate in 
some degree the absence of the natural function of the iris. 

2. Metallic Mixture for injecting Anatomical Preparations. — The following 
alloy is recommended: — R. tin by weight, 177 parts, lead 310, mercury 101.26, 
bismuth 497. The bismuth, tin, and lead are to be heated with a little pow- 
dered charcoal, until the mass comes into fusion; it is then to be removed 
from the fire, and the quicksilver gradually added after having been previously 
heated. The mixture has the brightness of silver, is perfectly fluid at 173° 9 
and becomes solid at 140°. 

3. Congenital absence of the Iris.— In our sixth Vol. p. 215, we noticed most 
of the known cases in which this rare malformation has occurred. Three ad- 
ditional cases, all occurring in the same family, have, however, since been re- 
lated by Dr. Hentzschel, of Chemnitz, in Saxony, in Amnion. Zeitschr. fur 
Ophthalmologic. The subjects of these cases are three sisters, whose mother's 
eyes are well formed, but the upper portion of the irides of their father's is 
entirely wanting. He is presbiopic, and cannot bear any strong light, and is 
subject to ophthalmia. In the eldest, aged twenty-eight, the iris is completely 
deficient — she suffers greatly from photophobia, and is almost constantly af- 
fected with ophthalmia. In the second sister, aged twenty-one, nearly the 
same symptoms are observable — there is no iris in either eye — she is affected 
with photophobia, and is exceedingly liable to ophthalmia. The sclerotic is so 
thin as to permit the choroid to shine through it at several points. In the left 
eye vision is very imperfect. In the youngest, aged thirteen, the sight is also 
impaired, though to a less degree than in her sisters. Their parents have two 
more children, a girl and boy, whose eyes are perfectly well formed. 

4. Nerves of the Cornea. — Professor Schlemm, of Berlin, is said to have dis- 
covered these nerves, and that they originate from the superficial branches of 
the ciliary nerves, and may be traced along the sclerotic coat, and over the 
orbiculus ciliaris towards the cornea, between which and the sclerotic they 
penetrate and become imperceptible. 



216 QUARTERLY PERISCOPE. 



PHYSIOLOGY. 

5. Experiments on Pulmonary Absorption and Exhalation. — M. Collaed de 
Martigny has published in the Journal Complementaire for May and August 
last, an account of some interesting- set of experiments, undertaken for the pur- 
pose of determining some of the disputed points in the chemical physiology of 
respiration. Not having received that Journal, we are indebted to the Edin- 
burgh Medical and Surgical Journal, for a summary of his principal results. 
They are the following: — 

1. According to the doctrine of Lagrange, which is a modification of the ori- 
ginal theory of Lavoisier, oxygen gas is absorbed in substance by the venous 
blood in passing through the lungs, and does not unite with oxygen to form 
carbonic acid till it has proceeded with the arterial blood to the capillaries. 
This opinion rests merely on some imperfect experiments by Girtanner, who 
thought he discovered oxygen in arterial blood. It is singular that these expe- 
riments should not have been repeated till now, as they obviously, if correct, 
lead to a very precise and important conclusion. On trying them, M. Collard 
de Martigny procured results decidedly negative. Having filled a tube thirty- 
six inches long with mercury, and reversed it so as to produce a barometric va- 
cuum, he admitted about an inch of fresh arterial blood from the crural artery 
of a living dog, and left the apparatus at rest for an hour and a kalf. At this 
time, the mercury having descended considerably, the gas which had been de- 
veloped was transferred into a graduated tube, and acted on by caustic potass. 
The whole of it was entirely absorbed, and consequently consisted of carbonic 
acid only. 

2. The more prevalent doctrine at present is, that the oxygen which is ab- 
sorbed by the blood in its passage through the lungs unites with the blood; that 
carbonic acid is formed in the capillaries by the various processes of nutrition 
and secretion; and that the carbonic acid thus formed is given off in the lungs 
by a process of exhalation and secretion, independently of the presence of oxy- 
gen. This doctrine rests mainly on an experiment first performed by Girtanner 
and afterwards more carefully by Edwards — where a frog, being made to 
breathe hydrogen alone, gave off nevertheless more than its own bulk of carbo- 
nic acid in the course of a few hours. This result, if the mode of experimenting 
is free from fallacy, is decisive of the question. It proves, that the carbonic 
acid given off during respiration, is not formed in the lungs by the union of 
oxygen with the carbon of the venous blood in its passage through the pulmo- 
nary circulation, but arrives with the venous blood in the lungs ready-formed, 
and is, in short, the product of the various functions of the capillaries. But M. 
Collard de Martigny considers, that even the method of experimenting pursued 
by Dr. Edwards its liable to fallacy. On the one hand, hydrogen and carbonic 
acid are so different in density that they mingle slowly, and in consequence an 
analysis of a portion of the mixture does not represent the composition of the 
whole mass. And on the other hand, according to a law in physics, the tissues 
of the body, being impregnated with carbonic acid, must give out that gas 
when immersed in an atmosphere of any other gas. To obviate the former fal- 
lacy he substituted azote for hydrogen; and to do away as much as possible 
with the latter, he withdrew and analyzed the air in which the animal was con- 
fined once every hour or every two hours and replaced it by pure azote — so that 
in this way he could ascertain whether carbonic acid was given out only at 
first, and therefore arose merely from the displacement of the gas diffused 
through the textures, or continued throughout the whole duration of the expe- 
riment, and consequently arose from the secretion of the gas by the lungs. In 
every experiment he found carbonic acid given out in considerable quantity as 
Edwards also invariably remarked. In an interval varying from seven and a 
half to nine hours, he procured in seven different experiments from 2£ to 2f cen- 
tilitres, or between 1J and 1J cubic inch of carbonic acid. In every instance 



Physiology. 217 

he found nearly twice as much gas formed during the first period, as during any 
subsequent period, which he attributes to the displacement of carbonic acid in 
the textures by the azote. But after the first period the quantity formed in 
every equal period of time was nearly the same till the animal began to become 
torpid and the respiration to languish, when the formation of carbonic acid ra- 
pidly decreased. Hence he concludes that after the first period, the carbonic- 
acid is derived solely from the blood in the lungs. 

The exhalation of carbonic acid from the lungs, then, is independent of oxy- 
gen being supplied to it. The presumption must consequently be, that it is se- 
creted or excreted by the blood in the lungs. But in order to establish this 
doctrine satisfactorily, it is necessary to show that the blood in passing through 
the lungs, really loses carbonic acid — a point which no one before M. Collard 
de Martigny has endeavoured to ascertain. He has proved it, however, as he con- 
ceives, by a comparative examination of the arterial and venous blood of the same • 
animal. When each was collected directly from the blood-vessels in a barometric 
vacuum, as formerly described, he found that venous blood almost always gave 
out twice, and on one occasion, thrice as much carbonic acid as the arterial 
blood. But when respiration was suspended by exhausting the lungs, and 
tying the trachea, the arterial blood was found to contain as much carbonic 
acid as the blood in the veins. 

5. Physiologists have differed with one another as to the question, whether 
the carbonic acid gas given out in the lungs is equivalent to the oxygen ab- 
sorbed by them; but, on the whole, the prevailing opinion is, that more oxygen 
is absorbed than is accounted for by the carbonic acid exhaled. M. Collard de 
Martigny arrives at the same conclusion by a series of experiments, apparently- 
more free from fallacy than any previously made. The chief difficulty is to 
avoid the fallacy arising from the probability of the air in the lungs of the 
animal at the beginning of the experiment not corresponding in quantity with 
what remains at the end. The author got rid, as he conceives, of this difficulty, 
by not confining the animal in the jar of air to be breathed, but by fixing a 
tube in its trachea, exhausting the air in its lungs, then establishing a commu- 
nication by means of the tube between the lungs and the jar, and, at the end 
of the experiment, expelling the residual air of the lungs into the jar by strong 
pressure of the chest. He has related the particulars of nine experiments of 
this kind, of which eight were performed with the rabbit, and one with the 
Guinea-pig. In four of them, the quantity of air breathed was four Hires, or 
244 English cubic inches; in four others, it was three litres and a half, or 213 
cubic inches, in one it was 183 cubic inches; and the duration of the experi- 
ment varied from nine to fifteen minutes. In the largest quantity of air, the 
quantity of oxygen was 51.2 cubic inches. Of this there remained unaccounted 
for by the residue of oxygen, together with the carbonic acid evolved, 6.5, 16.3, 
16.9, and 16.9 cubic inches in four different experiments. In the four ex- 
periments with 213 cubic inches of air, the total oxygen being 44.8 cubic 
inches, there remained unaccounted for, in like manner, 2.3, 4.7, 7.1, 10.4, and 
18.4 cubic inches. In the experiment with 183 cubic inches, where the oxy- 
gen was 38.4, the quantity unaccounted for was 4.7 cubic inches.* In all these 
experiments, then, it is clear, that a large, though variable quantity of oxygen 
gas disappears — a larger quantity is absorbed than is given off in the form of 

* The particulars are contained in the following tables, which are carefully calculated from the 
original tables of the author. 

Oxygen in Air before Oxygen 
Respiration. remaining. 

1. 51.2 22 

2. 27.1 

3. 22.6 

4. 20.3 

5. 44.8 17.4 

6. 14.4 

7. 19.7 

8. 18.7 

9. 38.4 15.3 



Carbonic 


Oxygen 


Acid. 


disappeared. 


12.3 


16.9 


17.6 


6.5 


11.8 


16.9 


14.6 


16.3 


17.0 


10.4 


12.0 


18.4 


22.7 


2.3 


19.0 


7.1 


18.4 


4.7 



218 QUARTERLY PERISCOPE- 

carbonic acid. But we must observe that M. Coilard de Martigny commits a 
serious oversight in supposing- that his method of experimenting is free of 
fallacy, or represents natural respiration. On the contrary, after the first in- 
spiration, the animal breathes an atmosphere considerably impregnated with 
carbonic acid gas; consequently the blood absorbs the gas, which it is very well 
known to do when a moderate proportion of carbonic acid in the air is pre- 
sented to it; and in this way the apparent disappearance of oxygen may be 
sufficiently accounted for. 

4. Another point of dispute among physiologists who have occupied them- 
selves with this subject, is whether any azote is given off or absorbed. On the 
whole, the greater number of authorities unite in finding that a small quantity 
is given off. But of late, much confidence has been reposed in the experiments 
of Dr. Edwards, who found that azote is sometimes absorbed, and sometimes 
given off, according to the season of the year. M. Coilard de Martigny is at 
variance, however, with Dr. Edwards on this point, having invariably found in 
many trials at different seasons that a small quantity of azote is given off. In 
the experiments formerly mentioned to determine the proportion of oxygen 
which disappears in respiration, he found in four trials with 244 cubic inches 
of air, that azote was exhaled to the amount of 1.9, 1.8, 1.6, and 0.1 cubic inch; 
in four trials with 213 cubic inches, the quantity exhaled was 4.1, 3.6, 1.8, and 
1.3 cubic inches; and in one trial with 183 cubic inches, the quantity was 4 
cubic inches. 

5. Lastly, M. Coilard de Martigny considers the question, whether any wa- 
ter is formed in the lungs by the union of the oxygen of the air with the hy- 
drogen of the blood. The idea that water is so formed has been, we believe, 
universally abandoned in Britain for some time, and we were not aware that 
this branch of the Lavoisierian doctrine of respiration still met with its favourers 
in France. It may be at the same time true, as our author states, that it is a 
notion more easily rejected than disproved. The objection first urged against 
it, that hydrogen never unites with oxygen at so low a temperature as 100°, 
was met with the rejoinder, that such union readily occurs when the hydrogen 
is in a nascent state. But M. Coilard. de Martigny objects, that according to 
his own experiments, and those of M. Chevallier, hydrogen is never in a 
nascent state brought in contact with azote without ammonia being formed, 
which he has never found in the halitus of the respiration. Another objection 
is, that whether common air or azote be respired, the quantity of halitus formed 
is prett) r nearly the same. 

In a paper which will appear presently, the author of the present essay un- 
dertakes to prove that animal heat is altogether independent of respiration. 

6. Animal Heat. — It has been maintained by many physiologists, that animal 
heat was entirely generated in the lungs by the process of respiration; and they 
attempt to account for its increase in those diseases in which the lungs are ren- 
dered impervious to air; by the supposition that respiration is in such instances 
carried on with more rapidity in the parts still pervious. A case entirely at 
variance with this hypothesis is related by Drs. Graves and Stokes. The pa- 
tient laboured under very extensive development of tubercles, had tubercular 
abscesses in the superior portions of both lungs, and general bronchitis. In this 
case, at a period when the skin was hotter than usual, and the pulse 126, the 
respirations were only 14 in the minute. — Dublin Hospital Reports, Vol. V. 

7. Circulation in Vegetables. — On the 27th of September, MM. Henri Cassini 
and Mirbel made a report upon the vegeto-anatomical and physiological 
observations presented by Dr. Schuetz to the Academy of Sciences. It appears 
that a circulation takes place in vegetables, comparable, in some respects, to 
that in animals. In fact, when the vessels in a portion of stem, an inch* or two 
long, and two or three lines in width, are considered, assent cannot be refused 
to the idea, that a vital juice exists, and that it passes several times by the same 



Physiology. 219 

path. But there is this remarkable difference between the circulation in ve- 
getables and in animals of a high order, that in the latter there is one point in 
which terminate two vascular systems very distinct from each other, one carry- 
ing the blood to the extremities of the body, the other collecting it and con- 
ducting it to its source; nor any double vascular system. Vessels of the same 
nature form a net-work, of which the meshes are so many similar circulating 
apparatus communicating with each other, so that there is a common motion 
through them whilst the parts live together, and a motion proper to each so 
soon as they are separated. The discovery of M. Schultz is of the highest in- 
terest for the anatomy and physiology of vegetables; it enlightens these two 
branches of science, the one by the other, and it proves relations to exist be- 
tween animals and vegetables, which before were not even suspected to 
exist. — Journal of the Royal Inst. G. B. Feb. 1831, from the Ann. de Sciences 
Nat. Vol. XXL 

8. Mutual action of Blood and Atmospheric Air. — Professor Christison, one 
of the most learned medico-legal jurists and skilful chemists of the present day, 
has communicated to the Royal Society of Edinburg, some extremely interest- 
ing experiments instituted for the purpose of ascertaining what changes really 
take place in the blood when exposed to the action of atmospheric air, and 
whether the arterialization of the blood in the lungs is a vital or physical pro- 
cess* 

It has generally been considered by physiologists and chemists, that when 
venous blood is brought into contact with atmospheric air out of the body, the 
blood changes its colour from dark purple to bright crimson, while the air loses 
a part of its oxygen and acquires carbonic acid. This has, however, been lately 
denied by Dr. John Davy, who states as the results of many trials, that atmos- 
pheric air and blood recently drawn from a vein have no mutual action what- 
ever; that the colour of the blood is not changed; that no oxygen disappears 
from the air, and that no carbonic acid is formed in it. With regard to the 
change of colour in the blood, Dr. Christison says that in his experiments, pur- 
ple venous blood always became, when agitated with air, brightly crimson, and 
the difference of tint was so great that no one could mistake the two varieties 
of blood. 

Dr. Christison is also at variance with Dr. Davy, as to the alterations which 
the air undergoes during- the changes effected in the colour of the blood, and 
his experiments appear to us conclusive. These experiments prove that when 
venous blood acquires the arterial colour by agitation with atmospheric air, 
that a considerable portion of the oxygen of the air disappears, that carbonic 
acid is formed, and that the process of arterialization, so far as regards the 
changes which the blood undergoes in colour, and the air in composition, is a 
chemical and not a vital phenomenon. — Ed. Med. and Surg. Journ. Jan. 1831. 

9. Seat of the Sense of Taste. — The following general experiments and con- 
clusions are from a work on the seat of this sense, by MM. Gutot and 
Admyrauld. I. If the anterior extremity of the tongue be enclosed in a very 
soft, flexible case of parchment, so as to cover it completely, jelly, and in 
general all bodies maybe introduced into the mouth, and crushed between the 
teeth without any taste being distinguishable. The same effect is obtained also 
by retaining the tongue apart from the cheeks or teeth; sapid objects placed 
beyond its action give no sensation of taste. The tongue, therefore, is the 
essential organ of taste; the lips, palate, cheeks, and gums have no power of 
this kind. 

II. Nevertheless, if the tongue be entirely covered, and very sapid substances 
be swallowed, a little taste is perceived at the posterior part of the velum 
palatum. If the palatal arch be covered with parchment, a sapid body pro- 
duces its ordinary effect upon the tongue. If a little piece of extract of aloes 
be fixed upon the end of a rod, and passed over the palate and the roof of the 



220 QUARTERLY PERISCOPE. 

mouth, it produces no other sensation than that of touching-; but on the ante- 
rior and upper part of the soft palate there is a small portion of surface, not 
having- definite limits, where the impression of sapid bodies is very sensible; 
the back part of the mouth does not partake in this property, so that this small 
portion of the palatal vault with the tongue forms the org-an of taste. 

III. If the tong-ue be covered with parchment, pierced at the middle of its 
back surface, sapid bodies applied to the part produce no taste, until, being- 
dissolved in the saliva, they gain access to the edge of the tongue. Extract of 
aloes passed over various parts of the tongue produce sapid impressions within 
a space of only one or two lines at the sides, three or four at the point, and 
within a curved space at the back. Hence this part of the tongue and the 
lateral portions are the especial organs of taste in deglutition; and to the portion 
of the soft palate already mentioned prolongs the sensation. — Journalofthe Royal 
Inst, of G. B. No. 2, from the Bib. Univer. 1830. 

10. Brown's Moving Molecules. — We gave in Vol. IV. p. 200, of this Journal, 
an account of the discovery of active molecules in inorganic bodies, by Mr. 
Brown, and at page 474 of the same volume, and p. 475, Vol. V. will be found 
some further illustrations of this curious phenomenon. M. Muncke, of Heidel- 
berg, has also been investigating this subject, and we find the following notice 
of his experiments in the Journal of the Royal Institution of Great Britain for 
February last. — M. M. finds the following a simple and easy mode of showing 
the motions of particles; — triturate a piece of gamboge the size of a pin's head 
in a large drop of water on a glass plate; take as much of this solution as will 
hang on the head of a pin, dilute it again with a drop of water, and then bring 
under the microscope as much as amounts to half a millet-seed; — there are 
then observable in the fluid small brownish-yellow points, generally round, 
(but also of other forms,) of the size of a small grain of gunpowder; distant 
from one another from 0.20 to 1 line. These points are in perpetual motion, 
varying in velocity, so that they move through an apparent space of 1 line in 
from 0.5 to 2 or 4 seconds. If fine oil of almonds be employed in place of 
water, no motion of the particles takes place, but in spirit of wine it is so rapid 
as scarcely to be followed by the eye. This motion certainly bears some re- 
semblance to that observed in infusory animals, but the latter show more of 
voluntary action. The idea of vitality is quite out of the question. On the 
contrary, the motions may be viewed as of a mechanical nature, caused by 
the unequal temperature of the strongly illuminated water, its evaporation, 
currents of air, heated currents, &c. If the diameter of a drop be 0.5 of a line, 
we obtain, by magnifying 500 times, an apparent mass of water, of more than 
a foot and a half broad, with small particles swimming in it; and if we consider 
their motions magnified to an equal degree, the phenomenon ceases to be 
wonderful, without, however, losing any thing of its interest. 



PATHOLOGY. 

II. Cause of Stammering. — In our sixth volume, p. 233, et seq. we published 
Br. Arnott's explanation of the nature of stammering; and we find in a recent 
No. of the Journalofthe Royal Institution of Great Britain some interesting ob- 
servations on this explanation, by Marshall Hall, M. D. which we will now lay 
before our readers. 

Dr. Hall is of opinion that Dr. Arnott's view of the subject is so far from 
being correct, that it is quite plain that it is only in the articulation of certain 
letters that expiration is interrupted, and even in this case the interruption is 
not in the larynx, the organ of voice, but in some part of the mouth, or organ 
of speech. " It will assist us," says Dr. Hall, " in the determination of the 
question, to take a review of the influence which the natural articulation has 



Pathology. 221 

upon respiration, or rather upon expiration. It may be ascertained, by the 
simplest experiment, that in the pronunciation of the short word BAT, we 
adopt a mechanism, by which not only the different letters are formed, but the 
respiration is twice completely arrested; — and that, in the pronunciation of the 
e.qually short word FAN, we first interrupt the flow of the air through the 
nostrils whilst it is forced between the teeth and lower lip, and then intercept 
the course of the air through the mouth, whilst we allow it to pass only through 
the nostrils. 

"It is on their influence on the respiration, that I formed the division and ar- 
rangement of the consonants, published in the nineteenth volume of this Jour- 
nal; their sub-division was founded on the respective mode or mechanism of their 
enunciation. I divided them — 

" 1. Into those, in the articulation of which both the mouth and the nostrils 
are closed, and the respiration, of course, completely arrested: 

"2. Into those, in the enunciation of which the nostrils are closed, but the 
mouth left more or less open, for the exit of the air, which is compressed, but 
not interrupted in its expiration: 

"3. Into those, not requiring even the nostrils to be closed, and in the 
enunciation of which the air is still less compressed in its course from the 
lungs: and, 

"4. Into those, in the articulation of which the expired air is not interrupted, 
and scarcely impeded at all. 

" Of the first class, are 

B D G* 
P ; T > K . 

" In tracing these letters into their sub-divisions, we may observe, that the 
first pair are labials, being formed by the lips compressed together; the second 
pair are linguo-dentals, formed by pressing the point of the tongue against the 
posterior and upper part of the upper teeth; and the third pair are linguo- 
palatal, being effected by pressing the middle part of the tongue against the 
palate. In all, the posterior apertures of the nostrils are effectually closed by 
the pendulous vail of the palate being drawn upwards, and accurately applied 
to their posterior apertures. And of course, those persons whose palate is 
perforated, or in whom the pendulous vail of the palate is imperfect, as some- 
times arises from disease, are more or less incapacitated from pronouncing these 
letters, the expired air being no longer intercepted, as it ought to be, in its 
course. 

" Of the second class, are 

^; the THf ; and |. 

"In the articulation of these letters, the posterior orifices of the nostrils are 
required to be closed, whilst, in the first pair, the compressed air is continually 
forced between the upper teeth and under lip; in the second, between the 
teeth and the tongue; and in the third, between the point of the tongue and 
the anterior part of the palate. 

"From this view of the subject, it will be readily apprehended how the sub- 
stitution of D or T for the TH, by foreigners, is so remarkable; for it is no less 
than the substitution of a total interruption, for a mere compression of the air, 
in its exit from the chest. 

" Of the third class of letters, are 

M; N; L; R. 

" In the enunciation of these letters, the expired air is only very slightly com- 
pressed, the nostrils being left freely open. It is for this very reason, probably, 
that these letters have been termed liquids, as flowing without obstacle. And 
it is by this circumstance, principally, extraordinary as it may appear, that the 
letter M differs from the letters B and P, for they are all equally labial; and 

* i. e. the hard G. t Hard and soft. 

No. XV.— May, 1831. 20 



222 QUARTERLY PERISCOPE. 

that the letter N differs from T and D, for they are all equally formed by plac- 
ing- the point of the tongue near the roots of the upper teeth. 

"Of the fourth and last class, are 

H; the Greek X; Y; and W. 

" In the enunciation of these consonants, the air appears to be scarcely com- 
pressed or impeded in its exit at all. This fact may, I think, account for the 
circumstance, that it has even been doubted, whether the two last letters be 
really consonants or not; and for the remarkable fact, that they cannot, as 
consonants, form the termination of any word. Their mechanism is guttural, 
double dental, and labial, respectively. 

" These letters, preceded as they are in this arrangement, by the liquids, lead 
us almost insensibly to the class of letters to be next noticed, namely, the 
vowels. 

"These are so called, from having- been supposed to relate to the voice 
alone.* This, however, is obviously an error. The different parts forming the 
mouth, or org-an of speech, are not less necessary to the enunciation of the 
vowels, than to that of the consonants, or their function less appreciable, on 
carefully making- the experiment. Thus, the French U is entirely labial; the 
letter E is dental; O, palatal; whilst the diphthong- AW, and the vowels marked 
in the French languag-e by the circumflex, (a,) are guttural. 

"Now let any one carefully examine the effort made by the stammerer in 
his attempts at the enunciation of these various letters. It will be obvious that 
the malady is but an exaggeration of the natural effort. In attempting to pro- 
nounce the letters of the first class, violent efforts are made, yet expiration — 
articulation — is not effected; but there is frequently, nay generally, a peculiar 
noise heard in the larynx, although its full enunciation is prevented by the 
action of the muscles of the mouth. But if the letters of the second class are 
pronounced with stammering, there is a perpetual hissing from the escape of 
compressed air, in the case of the letters F and V, between the lips, in that of 
the TH, between the tongue and upper teeth, and in that of the letters S and 
Z between the teeth. In the stammering enunciation of the letters of the third 
class, there is frequently a state of laborious respiration. In all these cases, 
then, it is plain that the larynx is open; any considerable effort applied to the 
parts concerned in the articulation of the first class of letters — the least noise — 
the least escape of air, alike demonstrate this fact. In the natural, and in the 
stammering articulation, there is the same total or partial interruption of the 
expiration, at the same parts, not of the larynx, but of the proper organs of 
articulation, only in different degrees. Let the larynx be really closed, which 
may be done after a little trial, and it will immediately be discovered that 
stammering is, in fact, impossible; the effort made by the force of the expired 
air against the parts of the mouth called into action in the articulation of the 
first class of letters — all escape of air — all noise, become totally interrupted. 

" I have just attentively watched the attempts of a stammerer to articulate the 
various letters. 

" In the effort to pronounce the first class of letters, especially the letter T, 
still more if two T's come together, as in the words THAT TREE, the face 
became flushed even from interrupted expiration; yet there was, at every re- 
petition of the effort, a noise audible in the larynx, proving that this part was 
unclosed. 

" In pronouncing the letters of the second class, a repeated hissing noise was 
distinctly produced by the flow of the compressed air, in one case, (F, V,) 
between the under lip and upper teeth; in the second, (TH,) between the 
tongue and upper teeth; and in the third, (S, Z,) between the teeth. 

"In attempting the articulation of some of the letters of the third and fourth 
classes, and of some of the vowels, the breath was sometimes lost, as it were, 
in a full and exhausting expiration, altogether peculiar. 

* Blumenbachii Institutiones Physiologise, Ed. MDCCCX, Sectio IX, 



Pathology. 22 3 

" All these results prove that the larynx is not closed in stammering, and 
indeed that its closure and stammering" are totally incompatible with each 
other. When expiration is interrupted, it is by the cooperation, the coadaptation, 
of parts anterior to the larynx; it is, in a word, not an interruption in the organ 
of voice, but in that of speech. The paralysis of the laryngeal muscles could 
not, therefore, effect the good which Dr. Arnott ingeniously supposes. 

" But would no evil really result from this paralysis of the muscles of the 
larynx? Would the 'loss of the faculty of closing the larynx 5 really 'be of no 
moment.'" On the contrary, the accurate closure of the larynx, not by the 
epiglottis, but by means of its own muscles, is essential to the act of degluti- 
tion. This is demonstratively proved by M. Majendie, in his interesting me- 
moir, ' Sur l'usage de l'Epigiotte dans la Deglutition.' The fact is further 
proved by cases of actual paralysis of the laryngeal muscles occurring* in the 
human body, and by the effects of inflammation and contraction, and of ulcera- 
tion of the internal parts of the larynx, in inducing defective deglutition." 

12. Nature of Diseases. — Sekttjerner, the celebrated chemist, has recently 
announced it as his opinion, that most diseases are owing to an inordinate 
acidity of the system; and accordingly proposes, for their prevention and re- 
moval, the free administration of alkaline remedies, especially carbonate of 
lime with calcined magnesia, mixed with sugar and mucilage. — Hecher Jlnnalen 
from der Jlnnalen fur das Universal System der Elementi, Bd. 3, 77. 2. 

13. Cancer of the Stomach with Perforation. — A case of chronic gastritis, 
which, as is too often the case, was mistaken for a spasmodic affection of the 
stomach, after being for a time apparently mitigated by the treatment, became 
suddenly much exasperated, and the patient sunk under the disease. On exa- 
mination after death, a perforation of the stomach was discovered, surrounded 
by a thickened and callous condition of its tunics. — Boeneck Medic, und Chirurg. 
Beobachtungen, 1829. 

14. Rupture of the Spleen. — An individual, aged about thirty-six years, of a 
choleric temperament, and irregular habits, received a blow by a hammer upon 
the left side, in the region of the lower false rib. Nothing remarkable was ob- 
served externally, but he experienced considerable depression and dyspnoea, 
which however seemed to be relieved by bleeding and internal antiphlogistic 
remedies. On the ninth day he was admitted into the hospital. At this time 
his countenance was pallid and sallow, his eyes dim, the respiration free, the 
fever urgent, the abdomen tumid and tender to the touch, and the bowels cos- 
tive, Extreme prostration soon supervened, with great restlessness and wan- 
dering of intellect, and death on the fourth day after his admission. Examina- 
tion of the body exposed a quantity of grumous blood extravasated in the cavity 
of the abdomen, and a rupture of the spleen. — Ibid. B. C. 3. S. 2. 

15. Gaseous Tumours of the Uterus. — Two very interesting cases of this de- 
scription are related in the fourth volume of the Opuscoli della Societa Medico- 
Chirurgica di Bologna. As we have not received that work, we translate from 
the December No. of the Revue Medicale the following notice of them. 

Case I. A plethoric female, in the prime of life, being suddenly exposed to 
cold during menstruation, the discharge was suppressed. Acute pain in the 
region of the uterus was quickly induced, as well as a marked augmentation in 
the size of this organ, which reached to the umbilicus. The patient was un- 
able to move her lower limbs, or even her body. To the chill with which the 
disease was ushered in, succeeded fever with exacerbations; in the evening 
there was thirst, and great uneasiness. On examination of the uterus, its tym- 
panitic condition was easily ascertained. A large bleeding from the foot, 
emollient fomentations, enemata of chamomile and of elder, did not at ail di- 
minish the condition of the uterus, which even became rounder: leeches were 



224 QUARTERLY PERISCOPE. 

applied to the vulva with no more success. The symptoms constantly aug- 
menting, another examination was instituted; the finger was introduced into 
the meatus uterinus, which gave issue to a quantity of foetid gas. The size of 
the hypogastrium diminished very sensibly, but soon again increased. Fumi- 
gations by means of a tube introduced into the uterus were then resorted to, 
which caused a very copious discharge of gas, accompanied with clots of blood, 
which continued several days, and produced a complete cure. 

Case II, Gaseous Tumour of the Uterus simulating Pregnancy. — A woman, 
aged forty, who had never had any children, exhibited some signs of pregnancy. 
The menses, which had always previously been regular, were suppressed; the 
meatus uterinus was entirely closed; the patient did not however experience 
any of the disorders which attend pregnancy. The uterus, however, towards 
the fifth month was as high as the umbilicus, moreover its form could be dis- 
tinguished by pressure with the hand. Such was the condition of this woman, 
when towards the sixth month all these prospects of pregnancy vanished; in 
stooping, a great discharge of flatus took place, the abdomen fell, and in a few 
days returned to its natural condition. 

16. Sub-maxillary Tumour produced by a hog's bristle in the Canal of Wharton. 
— M. Robert relates in the Revue Medicate, for August last, a case of this kind 
which occurred in a shoemaker. It was at first supposed to arise from a sali- 
vary calculus, but none could be discovered on sounding with a probe. After 
some months suffering, the extremity of a bristle was discovered projecting 
into the mouth, and extracted, and in a week the swelling, pain, &c. were dis- 
sipated. 

17. Bloody sweat, occurring during the Hysteric Paroxysm. — M. Chattffaiu) 
relates in the November No. of the Transactions Medicates, a curious case of a 
girl, aged twenty-one, small, sanguineous, menstruating irregularly, brain but 
little developed, mind weak, idle and obstinate, addicted to contemplation — and 
who was persecuted by her parents for having abjured her religion. She fled 
her paternal mansion, and after seeking various asylums, was admitted into a 
hospital. She was at that time subject to hysteric attacks, manifested by ge- 
neral convulsions, exquisite sensibility of the pubic and hypogastric regions, &c. 
&c. When the attack was violent, and continued for twenty-four or thirty-six 
hours, the patient went into a sort of ecstacy, characterized by fixed eyes, loss 
of intelligence, &c. and a bloody sweat was poured out by the cheeks and 
epigastrium; the blood was in small drops, and stained the linen. The whole 
cutaneous system was injected at the part which was the seat of the hemor- 
rhage, and the skin of this part was of a bright red, and covered with a vascular 
net-work. This phenomenon occurred whenever the hysteric catalepsy con- 
tinued for a long time or was exasperated by the impatience of the patient. 
These symptoms continued for three months, and then yielded to revulsive bleed- 
ings, and revulsive topical applications. 

18. Softening of the Right Optic Thalamus, with Paralysis of the whole of the 
left side of the Body. — A case of this description is related in the tenth No. Vol. 
I. of the Journal Universel et Hebdomadaire. The subject was a girl, aged ten 
years, admitted, October 11th, into the Hopital des Enfans, under the care of 
M. Guersent. There was complete paralysis of motion of the left side of the 
face, and of the superior and inferior extremities of the same side; the sensi- 
bility of these pails did not, however, appear altered. The intellectual facul- 
ties were not affected; there was intense head-ache. The patient died on the 
2d of November. On post mortem examination, the whole right optic thalamus 
was found softened to the consistence of pap, and of the colour of coffee and 
milk mixed together. In the centre of the thalamus, two denser bodies of 
the size of a pea were found, apparently softened tubercles. The corpora 
striata and the other parts of the brain, did not exhibit any abnormal appear- 



Pathology. 225 

ances. The spinal marrow was slightly softened; its membranes were healthy. 
This case does not support the views of certain physiologists, who maintain 
that paralysis of the lower limbs is dependent upon an affection of the corpora 
striata. 

19. Small-pox Infection Communicated to the Foetus in Uiero ivithout the Mother 
feeling any indisposition from its Action on her own Constitution. — We published 
in our last No. p. 555, a case in which this very curious phenomenon occurred. 
Since the publication of that No. we have met with accounts of several cases 
in which a similar occurrence took place, so that it appears not to be quite so 
rare an event as our correspondent supposes. Dr. Edward Jenner relates in 
the first volume of the Medico- Chirurgi 'cal Transactions of London, two cases of 
this kind, and alludes to one mentioned by Dr. Mead, and he says that he is 
acquainted with more examples of a similar description. As this is so inter- 
esting a pathological phenomenon, and as the work in which these cases are 
published is rarely to be met with in this country, we shall give a brief account 
of them. 

The first case is related by Dr. Jenner. Dr. J. was requested by Dr. Croft 
to vaccinate an infant, and scarcely any effect being produced beyond a little 
efflorescence on the part, which in a few days disappeared, Dr. J. expressed 
his surprise, when the mother related to him the following particulars: — 

"A few days previous to her confinement, she met a very disgusting object, 
whose face was covered with the small-pox. The smell and appearance of" the 
poor creature affected her much at the time; and though she mentioned the 
circumstance on her return home, she had no idea that her infant could suffer 
from it, having had the small-pox herself when a child. During a few days 
after its birth, the little one seemed quite well, but on the fifth day it became 
indisposed, and on the seventh the small-pox appeared. The pustules, which 
were few in number, maturated completely. Dr. Croft, who attended her, 
being curious to know the effect of inoculation from one of the pustules, put 
some of the matter taken from one of them, into the hands of a gentleman 
eminently versed in that practice, which produced the disease correctly. Mrs. 
W. was not sensible of any indisposition herself from this exposure, nor had 
she any appearance of the small-pox." 

The following case, similar, in its general character, was communicated to 
Dr. J. by Mr. Henry Gervis. During the prevalence of a small-pox epidemic, 
Mr. Gervis vaccinated, a woman in the last month of her pregnancy. "Her 
three children had been inoculated the preceding day with variolous matter by 
the surgeon who attended the poor of the parish, and who had very properly 
declined inoculating- her also, from her particular situation. I made two punc- 
tures in each arm, each of which fortunately succeeded, and she regularly 
passed the disorder, complaining only on the tenth and eleventh days, when 
the areola was most extended, as is usual. 1 saw her very frequently during 
the progress of her disorder, and once or twice after its complete termination: 
I therefore can speak positive!) 7 , that during that time she laboured under no 
symptom but what is connected with the cow-pox. From this period she con- 
tinued perfectly well, and on Saturday last, the 11th instant, she was delivered 
of a female child, having at the time of its birth many eruptions on it, bearing 
much the appearance of small-pox in the early stage of the disease. This event 
happened five weeks after her vaccination, and one month after she had been 
exposed to the variolous infection of her own three children, and that of several 
other persons in the same village. On the 14th I visited the child again, when 
i found the eruptions had increased to some thousands, perfectly distinct, and 
their character well marked. Many among the most respectable physicians 
and surgeons from Totness, Ashburton, and the neighbourhood, were kind 
enough, at my request, to come to the poor woman's place of abode, and wit- 
ness the fact. But to put the matter beyond all doubt, I armed some lancets 
with the virus, and produced the small-pox by inoculating with it. On the 

20* 



226 QUARTERLY PERISCOPE. 

18th the infant was seized with slight convulsions, and on the morning of the 
19th, it expired." 

The following case is related by Dr. Mead, in his discourse on small-pox. 
" A certain woman, who had formerly had the small-pox, and was now near 
her reckoning, attended her husband in the distemper. She went her full time, 
and was safely delivered of a dead child. It may be needless to observe, that 
she did not catch it on this occasion; but the dead body of the infant was a 
horrid sight, being all over covered with the pustules; a manifest sign that it 
died of the disease before it came into the world." 

20. Case of Putrefactive Disorganization of the Lungs. By Robert Law, A. 
M., M. B. — John Dunne, tailor, aged nineteen, of a thin delicate habit of body, 
was admitted into Sir Patrick Dunn's Hospital for fever, in the progress of 
which he was seized with a profuse expectoration of fluid arterial blood, which 
he said he had often had before his admission; his pulse was small and rapid. 
(R. Misturae Camphorae, 3V.; Tinctur. digitalis, gutts. xxx. ; Tinctur. opii, gutts. 
xx.; Syrupi, gss. Misce sumat unciam omni trihorio.) The haemoptysis ceased; 
in the course of the fever, he exhibited symptoms which gave strong grounds 
for suspecting effusion in the head, by becoming comatose, the pupils widely 
dilated did not obey the stimulus of light; these symptoms, however, yielded 
to the application of cold wash to the shaved head, a blister to the nape of the 
neck, and sinapisms to the feet; his febrile symptoms soon disappeared, but he 
complained of a teasing cough and palpitation of the heart, for which I repeat- 
ed the camphor mixture and digitalis, with the following pills: — 

R. Extract conii gr. viij. 

Pilulae ipecacuanhae gr. iv. fiant pilulae quatur una tertiis horis sumend. 

These lessened the heart's action and the irritation of the cough, but he was 
much debilitated, and perspired much at night. I in consequence ordered 
bark and sulphuric acid, and the tepid shower bath, from which he seemed to 
gain strength. I now lost sight of him for some time, when he came to me to 
complain of the unceasing irritation of the cough; he was much emaciated and 
decidedly hectic; his breath and expectoration were extremely foetid; in all the 
right lung respiration could scarcely be heard; under the left clavicle was im- 
perfect pectoriloquy; he died in two days from this, about six weeks since his 
first admission into hospital. 

Examination fifteen hours after death; head not examined; the apex of the 
right lung adhered so firmly to the corresponding part of the cavity of the chest, 
that it could not be separated without breaking its structure; this lung was 
much heavier than natural, and felt quite solid, except at its base; the invest- 
ing pleura was universally thickened, and in some places had acquired the den- 
sity of fibro-cartilage. The entire substance of the lung, except the base, was 
thickly studded with tubercles; the pulmonary tissue surrounding these bodies 
was either broken down into a soft brownish sloughy substance, or so condens- 
ed, as to have its cellular nature quite destroyed; there were many irregular 
cavities traversed by bands of pulmonary structure; the surface of each cavity 
exhibited a blackish sloughy appearance; the base of the lung was quite free 
from tubercles, but was in the first stage of pneumonia. 

The left lung exhibited a similarly disorganized condition, the small irregu- 
lar cavities were more numerous, and the intervening pulmonary structure 
softer, presenting the same dirty, sloughy broken down appearance. On pur- 
suing some of the bronchial ramifications which opened into these cavities, 
their lining membrane was highly vascular, and, in some instances, black; the 
base of this lung, too, was in the first stage of pneumonia, and free from tuber- 
cles; the left cavity of the pleura contained about a pint of straw-coloured se- 
rum; the pericardium about eight ounces of the same fluid. There was also 
an infiltration into the sub-serous tissue, connecting the substance of the heart 
and the pericardium; the heart was small and flabby; the abdomen contained 
about two quarts of serum, all the viscera of this cavity were healthy. 



Pathology. 227 

We here have an instance of the disease, combined with tubercular phthisis, 
and, in consequence, running a much more rapid course, and exhibiting- a more 
distinctly marked hectic fever, than the uncomplicated disease ordinarily does. 
As usual, it was ushered in by a profuse hemorrhage, to which succeeded 
cough with foetid expectoration; as in ordinary phthisis, the superior portion of 
the lung was the point de depart of the disease. 

A striking circumstance in this case is, the effusion into all the serous cavi- 
ties, which I suspect also took place into the brain, when the coma, dilated 
pupils, &c. gave evidence of its existence. — Transactions of the Associativa of 
Fellows and Licentiates of the King and Queen's College of Physicians in Ireland, 
N. S. Vol. I. 

21. Haematemesis dependant upon disease of the Liver. By Robert Law, A. 
M., M. B. — Mary Freyne, aged forty-three, married, four days since was sud- 
denly seized with vomiting of blood, and had bloody discharges from the bow- 
els, which continued up to the period of her admission into hospital. On the 
day on which she was admitted, she vomited not less than a quart of coagu- 
lated blood, and exhibited all the symptoms characteristic of such a loss; coun- 
tenance pale and exsanguinous; lips livid; expression anxious; temperature of 
lower extremities below the natural state; surface of the body bedewed with 
cold clammy perspiration; pulse frequent and feeble; fluttering of the heart; 
voice faultering; (entrecoupee.) — (R. Infusi rosx, 3V.; Sulphat. magnes. ^vi.; 
Acid sulphuric dilut. gss. ; Tinctur digitalis, gutts. xxx. Misce, sumat unciam 
3tiis. horis, vini rubri 3|yi, Legs to be wrapped in flannel; jars of hot water to 
be applied to the feet.) 

November 28. — Vomited very little blood, but had frequent tarry discharges 
from the bowels; seemed quite exhausted; pulse very small and thready; sur- 
face of the body cold; countenance anxious; frequent sighing; all her symp- 
toms bespoke approaching dissolution. Wine not seeming to revive her, I 
substituted French brandy; she died in the course of the evening. 

Examination fifteen hours after death; body not in the least emaciated; lungs 
quite healthy; heart soft, flabby and pale, containing a small quantity of fluid 
blood; a small quantity of serous fluid in the abdomen; the stomach contained 
about a pint of blood, and the intestines much of the black tarry matter which 
was discharged by the bowels. The entire tract of the gastro-intestinal mucous 
membrane so far from exhibiting any unusual vascularity, seemed quite blanched, 
The liver presented an irregular tuberculated or granulated surface; was 
contracted in size; its anterior margin much less acute than natural. A sec- 
tion of it exhibited small round bodies of various dimensions, separated by 
dense fibro-cellular septa; this fibro-cellular tissue seemed to be the proper 
cellular tissue of the organ increased in density, furnishing loculi or capsules 
to these roundish bodies, which are probably the acini in a state of hypertro- 
phy; these bodies adhered loosely to their capsules, and could be easily de- 
tached from them; the consistence of the organ was greater than natural; its 
colour a whitish grey. — Ibid. 

22. Ossification of the Mitral and Aortic Valves, with Induration of the Tri- 
cuspid, Hypertrophy and Dilatation of both Auricles, Ventricles sound. — The fol- 
lowing case, related by Patrick Clinton, in Vol. I. N. S. of the Transactions 
of the Dublin College, is particularly interesting, from the degree of ossifica- 
tion in the valves of the heart. Bertibt says that in the course of 20 years' 
practice, he never witnessed more than four cases of indurated tricuspid valves, 
and that he has in general seen it to accompany a direct communication be- 
tween the right and left cavities. 

Ellen Printer, aged twenty-five, was visited on September 19, 1828. She 
was of a delicate constitution, and stated that she had often miscarried. She 
complained of dyspnoea, and frequent palpitations, sometimes so violent as to 
shake the whole bed; remained always in the sitting posture; enjoyed no sleep; 



22 S QUARTERLY PERISCOPE. 

had a hard cough, with sometimes a bloody expectoration; and the feet were 
cedematous. The contractions of the ventricles were accompanied with a loud 
and distinct bruit de soufBet, which, on account of emaciation, was heard all 
over the anterior part of the chest. On the following" day she was much reliev- 
ed from the dyspnoea, had enjoyed some sleep, and was covered with perspira- 
tion, chiefly about the head and upper part of the body. She had taken gentle 
laxatives with tincture of digitalis. This latter medicine was continued, but 
with very little benefit; for on the next day the palpitation was very violent, 
but the noise of the heart not so loud. Its impulse was observed to be strong- 
est between the third and fourth cartilages of the left side. Percussion gave 
but a dull sound in the region of the heart. The right arm was affected with 
severe pain from the shoulder to the tips of the fingers, and its colour had been 
livid in the earlier part of the day. She stated that four months ago she had 
been affected with paralysis of the right side. 

On the 24th she enjoyed a considerable degree of ease? the pulse was much 
slower, and the impulse of the heart very considerable along the whole ster- 
num. The sound of the ventricles was heard all over the anterior part of the 
chest. The heart's action was very irregular: the stroke of the ventricles very 
long, that of the auricles could hardly be distinguished, and there followed an 
intermission which was equal in duration to both. On the 25th the pulse was 
100, and the beating of the heart less violent, but very irregular. First, there 
were two or three strokes with a long intermission between them, and then 
followed an equal or a greater number in rapid succession. The expectoration 
was this day less bloody, and the respiration was observed to be puerile under 
the left clavicle. The edg-e of the liver was felt for the first time below the 
navel. From this day until the 2d of October, she continued nearly in the 
same state, deriving little benefit from the use of digitalis, which was exhibited 
under various forms. At the latter period the legs were swelled up to the 
knees; the impulse of the heart w as less; but the noise loud and peculiar. The 
contractions of the ventricles were accompanied with a noise which had some 
resemblance to the rolling of a cart. The pronunciation of the word thurld, 
will convey some idea of the sound, which accompanied their slow contrac- 
tions. The sibilous rattle was heard wherever the respiration was audible. 
The urine was scanty, and the sputa less coloured with blood. She complained 
of a severe pain in the small of the back, which was aggravated by speaking or 
motion. 

On the 8th of October she was a good deal worse, the anasarcous swelling of 
the legs undiminished, orthopncea, palpitation and haemoptysis, with paleness 
of the countenance. On the 10th and 11th the respiration was heard only at the 
upper part of the chest. She was obliged to sit up in bed constantly, and could 
hardly speak; but the functions of the brain continued undisturbed. She died 
at 9 o'clock, P. M. with extraordinary efforts of the respiratory muscles. 

Examination of the Body. — The extremities were anasarcous. The liver was 
much enlarged and very hard; its external surface appearing as if minute grains 
of sand were imbedded in it. These grains were closely set, and so numerous 
as to cover almost the whole surface of the liver. The right lung adhered to 
the pleura costalis. There was no water in either pleura. The pericardium 
was distended by a large quanthy, (a quart or more,) of a greenish-yellow trans- 
parent fluid, with a very few flakes of soft lymph floating through it. The 
heart, especially the auricular portion, was distended by a quantity of clotted 
blood. The mitral valves were so much ossified, that the passage from the left 
auricle into the left ventricle, was reduced to a mere chink, of a form some- 
what semicircular, large enough to admit the blade of an ordinary scalpel; but 
not so large as to admit the handle. This form and size of the auriculo-ven- 
tricular opening was produced by the complete ossification of the opposing 
valves, which stood up from their bases, (on which they were quite immovea- 
ble,) and projected forwards towards each other so as almost to meet, and in 
part of their length actually to meet each other. The edges of the valves were 



Pathology. 229 

very irregular and nodulated, and so much thickened, that the passage between 
them from the auricle into the ventricle was of considerable length. There 
was a good deal of ossification under the lining membrane of the parts in the 
immediate vicinity of the valves. The columns carneae and chords tendinex 
were thicker and stronger than usual. The auricle was thickened in its parie- 
tes, presenting, in some places, a muscular layer of a quarter of an inch in 
thickness; its cavity was so much enlarged, as nearly to admit a closed hand. 
The ventricle was in the natural state. On looking from the aorta towards the 
ventricle, the aortic valves were seen standing up, so as nearly to close the pas- 
sage, but still leaving an opening between their edges, large enough to admit a 
small pea. When the point of the little finger was applied to the opening on 
the side of the ventricles, and a slight pressure used, the valves yielded so as to 
allow the point of the finger to enter the aorta, and the opening to increase to 
about twice its former magnitude; the valves at the same time closely embrac- 
ing, and pressing upon the finger with an elastic force. On withdrawing the 
finger the valves returned immediately by their elasticity to their former situa- 
tion, and the opening was reduced to its former size. The ossification of these 
valves was very imperfect, but they were considerably thickened. There were 
two or three minute points of ossification in the aorta, at about the distance of an 
inch from the heart. The tricuspid valves were also thickened and imperfectly 
ossified, and stood up a little from the sides of the ventricle. The right ven- 
tricle, and the valves of the pulmonary artery were quite healthy; the right 
auricle thickened and enlarged, but not so much as the left. There was no 
appearance of unusual vascularity, or of false membrane on any part of the 
heart. The lungs were not cut into; externally they appeared sound. — Ibid. 

23. Case of Attempt at Suicide, with Danger of Suffocation by the Falling 
Down of the Epiglottis. By John Houston, Esq. — In March, 1828, a servant 
out of place, residing in Duke street, during a fit of delirium brought on by 
intoxication, attempted to destroy himself by cutting his throat with a razor. 
I saw him in about ten minutes after, and found him almost lifeless. The pul- 
sations of the heart were imperceptible, the pulse at the wrist had ceased to 
beat, the limbs were cold, and all feeling and consciousness lost. The wound, 
which was frightfully deep, extended more towards the left than the right ear. 
The razor had entered between the os hyoides and the thyroid cartilage, and 
disunited them so completely as to allow the former to ascend with the tongue 
into the mouth. The pharynx was laid wide open, and the epiglottis severed 
from its attachments to the tongue and os hyoides, and left hanging by its pe- 
dicle to the back of the pomum adami. The carotids had escaped untouched, 
and the bleeding was inconsiderable. It appeared difficult at the moment to 
account for the sudden extinction of life; the symptoms were evidently those 
of suffocation, but the cause was not at first understood. I passed my finger 
into the wound, and found, to my surprise, that the epiglottis, loosened from its 
upper and lateral attachments, had fallen back over the rima glottidis, and com- 
pletely intercepted the passage of air to the lungs. I raised the obstructing 
body and drew it forwards: the chest soon after began to heave, respiration re- 
turned, the heart and pulse again beat, and consciousness and sensibility were 
reestablished. 

It required some effort of my fingers to hold up the epiglottis, as the air at 
every inspiration tended to force it back again to its unnatural and dangerous 
position. 

While thus occupied with the patient, Surgeon Porter entered the room; I 
explained to him the singular nature of the case, and how between my finger 
and thumb I held the regulation of the man's life or death. The top of the 
epiglottis was then brought over the edge of the thyroid cartilage, and secured 
to its anterior surface by a single stitch. The man in a short time sat up and 
attempted to speak, but was unable to articulate. He was taken into the Meath 
Hospital under the care of Mr. Porter, from whom I learned that he never re- 



230 QUARTERLY PERISCOPE. 

covered from the delirium which led to the perpetration of the act, and died 
in about a week after, of erysipelatous inflammation of the neck and throat. 

The circumstance which had so nearly extinguished the life of this individual 
the instant after the wound was inflicted, is too plain to require comment; but 
the fact of its occurrence, and of the facility with which the immediate danger 
arising from it may be averted, is too important not to be made generally known. 
A respite of life for even a few hours in cases such as this, may be often of in- 
finite value.* — Dublin Hospital Reports, Vol. V. 

24. Internal Strangulation of the Bowels after Parturition. By Johx Houston, 
Esq. — A lady about 28 years of age, and the mother of several healthy chil- 
dren, to all of whom she had given birth without any untoward symptoms, was 
delivered of a healthy boy, her last child. 

During her pregnancy she had experienced no unusual inconvenience, but 
immediately after the birth of the infant she complained of severe pain in the 
abdomen, which became violently aggravated on the placenta being discharged. 
No evacuations could be procured from the bowels, the belly became swollen 
and tense, and the pulse remarkably quick and small. She sunk rapidly under 
symptoms of the most acute peritonitis, and notwithstanding the most energetic 
treatment, expired in about thirty -four hours from the time of delivery. 

Dissection. — The uterus had contracted, and nearly retired into the pelvis. 
The entire peritoneal surface exhibited all the marks of intense inflammation, 
and the ileum, to the extent of about three feet, was completely sphacelated, 
black, and filled with blood. A band of lymph, two inches long, and of con- 
siderable thickness and solidity, was attached by one end to the right ovarium 
and fallopian tube, and by the other formed a tight noose around the mesentery 
of the mortified gut, which thoroughly strangulated and deprived it of circula- 
tion. The extravasation of blood, which had taken place into the cavity of the 
intestines, and among its tunics, marks the tightness of the ligature. 

It would appear, from the absence of any disagreeable symptoms during 
pregnancy, and the rapidity and violence with which they followed the birth of 
the infant, aggravated still more after the discharge of the placenta, that the 
adhesion between the ovarium and mesentery had been contracted while the 
uterus was high in the abdomen, and that the descent of that organ after parturi- 
tion drevj tight the band which strangulated the bowels. — Ibid. 

25. Case of rupture of a vesselin ths. Brain from a shock. By Charles Beli, Esq. 
— " A young woman, carrying in her arms her first child, about six months old, 
slipped her foot, with a slight shock, but it was on plain and even ground, and 
she did not fall down. In the instant of this shock she was sensible of a sudden 
pain in the right side of her head; it was so peculiar that she said she could co- 
ver the point with her finger, and though slighter at intervals, this pain never 
left her to the moment of her death. She walked home, went about her little 
family matters, suckled her child, but was seized that evening with sickness, 
not violent, like that of any sudden disease, but rather like the easy vomiting 
of a pregnant woman. 

" She continued very sick, with slight head-ache; but still was out of bed all 
day long, went about her household affairs, and had no symptom which could 
lead one to suspect her very dangerous condition, or what a dreadful accident 
had happened. She got up during the night after this accident for some cool 
drink, felt herself extremely giddy, was obliged to support herself by a chest 
of drawers which stood by her bed-side, and went to bed again immediately. 
On the evening of the second day she got out of bed, made tea as usual, was 
out of bed during the evening, had no complaint, except the continual sickness, 

* Since the report of this case, I have observed in Blandin's Traite d'Anatomie Topograpbique the 
following paragraph, which shows that if the accident alluded to has escaped notice, the possibility 
of its occurrence has been at least contemplated. He says, " L'epiglotte neanmoins, qui est alors 
ccupee, peut par son abaissement sur le larynx causer des graves accidents." 



Materia Medica. 231 

slight pain of the head, and giddiness still slighter. That night she expired, 
Her pulse all along had beat low and weak, and never more than sixty in a mi- 
nute. 

" When I was brought to open the body, I heard nothing of the pain of her 
head, though it was fixed and constant, and withoutthat nothing could be more 
puzzling than this combination of circumstances. First the sudden slipping oi' 
her foot, and the incessant sickness which ensued, suggested the idea of her- 
nia, but no such secret was known among her relations, and upon opening the 
abdomen, no hernia was found, neither open nor concealed, as in the thyroid 
hole. 

"Next we were informed of a palpitation which had been usual with her. It 
appeared that she had complained chiefly about the period of her first men- 
struation, and before marriage. It seemed to be hysterical merely, but upon 
opening the thorax, we found the heart wonderfully enlarged and crammed 
with a dark and grumous blood. 

" But next a new scene opened upon us, and this enlargement of the heart ap- 
peared to arise like that of the liver, which so often accompanies fractured 
skull, from the languid action of the heart and torpor of all the system in those 
who lie even for a few days comatose. Now for the first time I was informed 
that the shock of slipping her foot had caused a sudden pain of her head: that 
it was pointed, confined to one single spot, incessant, accompanied with vomit- 
ing or desire to vomit, and with giddiness during the night. 

"Upon opening the head I found the dura mater of a most singular appear- 
ance, livid, or rather like the gizzard of a fowl, with green and changing co- 
lours. Having cut it open, the pia mater appeared like red currant jelly, with 
fresh coagulated blood so firmly attached to it, that it seemed as if driven into 
its very substance and incorporated with it. Upon cutting and tearing open 
the pia mater, each convolution of the brain was surrounded and separated from 
that next it by coagulated blood. Upon cutting into the ventricles of the brain, 
that of the right side was found to contain four ounces of entire and coagulat- 
ed blood; the cavity at first view was like opening a ventricle of the heart; the 
blood, very dark, and firmly coagulated, was forced out by the pressure of the 
surrounding parts; the coagulum became gradually firmer and whiter, till it 
turned to a very firm stringy clot, which stuck in the mouth of the middle ar- 
tery of the brain. Being carefully examined, it was found to be sticking firm in 
the mouth of the artery which had burst, as if by the separation of two of its 
rings. The blood which thus filled the right ventricle had also made its way 
down in prodigious quantity into the third and fourth ventricles, quite into the 
occipital hole; but the opposite ventricle it had not filled." 



MATERIA MEDICA. 

26. Salicine. — This article, which has lately been introduced into the materia 
medica, is thus described by MM. Pelouze and Jules Gat Lussac. Salicine, 
when pure, forms white crystalline prismatic needles. It has a bitter taste, and 
somewhat of the odour of willow bark. One hundred parts of water dissolve 
5.6 parts of salicine at 67° F. : at 212° F. it appears to dissolve in any propor- 
tion. It is equally soluble in alcohol, but ether and oil of turpentine take up 
no portion of it. Concentrated sulphuric acid gives it a fine red colour, like 
that of bi-chromate of potassa. Muriatic and nitric acids dissolve it without 
producing any colour. It is not precipitated from its solution by infusion of 
nut-galls, gelatine, neutral or sub-acetate of lead, alum, or emetic tartar. It 
does not saturate lime-water when boiled with it in excess: it does not dissolve 
oxide of lead: it fuses a little above 212° F., losing no water, and crystallizes 
upon cooling. If the heat be rather higher, it acquires a lemon-yellow colour, 
and becomes, when cold, brittle as resin. 



232 QUARTERLY PERISCOPE. 

Salicine, burnt by means of oxide of copper, yields a gas entirely absorbable 
by potash. The mean of two analyses gave the following as its composition. 

Carbon . . 55.491 = 2.028 proportions. 

Hydrogen . 8.184 = 2.004 

Oxygen . # . 36.325 = 1.000 " 
Its composition may, therefore, be represented by two volumes of olefiant gas, 
and one volume of oxygen. — Jinn, de Chimie, Vol. XL1V. 

27. JEtherous Extract of the Semen Santonici as a Vermifuge. — The seeds and 
stems of the Semen santonici have long been employed for the purpose of de- 
stroying worms, but the difficulty experienced in taking it in form of powder, 
has been so great, that it has been much less employed in modern times than 
formerly. Jehn, an intelligent apothecary of Germany, has succeeded in ob- 
taining a preparation of this substance free from the objections which have 
hitherto existed, and which has proved a most efficient anthelmintic in the 
hands of several distinguished practitioners. It is prepared as follows: — Digest 
four ounces of the seeds, previously bruised, in sixteen ounces of sulph. 
sether, for three or four days, frequently shaking the mixture: then draw off 
one-fifth part of the xther by distillation, and bring the residue to the consis- 
tence of an extract, by digesting it in a sand bath, with a very moderate heat. 
It is of a dark-brown colour, having the odour of the seeds, is bitter to the 
taste, and dissolves readily in sether and alcohol, but not in water. It is ad- 
ministered to children from one to two or three years, in doses of from one to 
three grains; above this age, four or five grains, and to adults, ten grains. — 
Journal fur Practischen ffeilkunde, von Huf eland and Osann, LXX. Band. 1, 
Stuck. 1830. 

28. The Ointment of Mezereon as a Dressing to Maintain a Permanent Dis- 
charge from Issues, &c. — It is well known that in many cases, where the un- 
guent, cantharid. is employed as a dressing to a denuded surface, strangury is 
developed, and occasions the patient much distress. To obviate this inconve- 
nience, Professor Hufeland has proposed to substitute the unguent, mezerei, 
which he thinks possesses many advantages over the other. The following is 
the formula which he recommends for its preparation: — R. extract spirituous, 
cort. mezerei, gj.; axung. pore, ^ix., cerae. alb. §j.; salve extr. in unc. und 
alcoholis, adde axungiam et ceram et misce modico calore continue agitando, 
usque ad perfectam evaporationem alcoholis: tunc cole. — Journal der Practis- 
chen Heilkunde, Band. 70, Stuck. 1. 

29. New Styptic. — M. Bostafotjs has communicated to the Royal Academy of 
Medicine, that he has succeeded with a powder composed of equal parts of 
rosin, carbon, and gum arabic, in arresting hemorrhage from large arteries. 
The author related several cases in which its application to the divided brachial 
artery in man, to leech bites, to the carotid artery of a horse, &c. had entirely 
arrested the flow of blood.— Gazette Medicate, Feb. 1831. 



PRACTICE OF MEDICINE. 

30. Chronic Gastritis.— The following case, with the accompanying remarks, 
are from a clinical lecture delivered at St. Thomas's Hospital in December last 
by Dr. Elliotson, one of the most judicious and sensible practitioners in London, 
and we solicit for them an attentive perusal. The accordance of these obser- 
vations with the doctrines so often advocated in this Journal will be observed, 
and although we may not be prepared to admit with Dr. Elliotson that these 
doctrines have been long prevalent in Great Britain, yet we consider this of 
little importance, so that their utility and correctness be admitted. 



Practice of Medicine. 233 

Maty Harrison was admitted on the 7th of October, setat. fifty: she had been 
ill two months. The symptoms were constant, and great pain under the region 
of the heart, which was exceedingly increased on pressure. It appeared to be 
situated in the splenic half of the stomach. There was constant nausea, and a 
great discharge of fluid from the throat, and she had spit up two or three times 
dark clots, apparently of blood, and such clots had frequently passed from the 
rectum. In the book it is said she feels well, and is nauseated as soon as she 
eats: there is constant heat of the epigastrium, constant heat up the throat, and 
thirst: a bad taste in the mouth, no appetite, great heat of the whole body, es- 
pecially at night? cheeks flushed, scalding pain in the stomach as soon as she 
takes wine or any other kind of stimulant. These were the symptoms, and 
nothing could more decidedly show an inflammation of the stomach. Here was 
in the first place, pain in the region of the stomach; this pain was constant, was 
increased on pressure and on taking any sort of stimuli. There was also great 
nausea, great heat in the stomach, and this sense of heat amounted to scalding, 
and was increased by wine or any other kind of stimulant. Then there was 
excessive secretion going on there, for her mouth was constantly filled with 
fluid,- she frequently discharged a large quantity of thin liquid, and now and 
then even blood came away, which is a common thing from any affection of a 
mucous membrane; not that there was any extent of it — it was only a few dark 
clots. Besides these local symptoms of inflammation, there were general 
symptoms. There was great heat, and the face was flushed, she was very 
thirsty, and her pulse was 90. Besides these general and local symptoms of 
inflammation there was a disturbed state of the stomach, anorexia, and nausea 
as soon as she took her food, and vomiting of these dark clots which came to 
her throat. You know that one of the sets of symptoms in inflammation is that 
arising from, disturbed function of the affected organ. She was also emaciated, 
and her bowels were so costive, that frequently she had not a stool for a whole 
week. Costiveness is not an uncommon symptom in any inflammation, and it 
very frequently occurs where the stomach is inflamed. 

Now this is a sort of case which you will see almost every day. You will have 
people come, saying that they have indigestion, and upon inquiry you will find 
that there is tenderness on pressure upon the stomach, and pain increased as 
soon as they take wine or brandy, or any thing of that description, and notwith- 
standing that, they go on eating and drinking, and taking stimulants. 

I found it impossible to say whether this woman was labouring under simply 
chronic inflammation of the stomach, or whether there was united with it or- 
ganic disease. It was impossible for me to say whether there might not be 
scirrhus in some parts of the stomach — whether there might not be some 
fungous growth beginning, as well as an inflammation around it — or whether 
there might not also be an ulcer in the stomach. Unless you can feel indura- 
tion — unless there is repeated haemorrhage, and a peculiar sallow hue of the 
complexion — unless you can feel enlargement, it is quite impossible in these 
cases to say with any certainty, that there is any thing more than common in- 
flammation. 

- The treatment, however, is to be that simply of chronic inflammation. If 
there be organic disease, you will not cure it, and, if not shown distinctly to 
exist, you must proceed upon the hope that there is nothing more than chronic 
inflammation. If there be organic disease, there maybe much inflammation of 
course around it, and though you will not lessen the organic disease by the re- 
medies for inflammation, you will lessen the amount of suffering. There are 
so many cases of disease thought to be organic, which are nothing more than 
chronic inflammation, that in every instance, unless there be evidence to the 
contrary, we are to act upon the hope that there is no organic disease, and by 
so acting we may cure a considerable number. This woman was in a state of 
great emaciation, and therefore, I confess, I feared the worst — that there was 
probably something more than chronic gastritis. I set to work, however, upon 
the presumption that there was mere inflammation. She took not a grain of 

No. XV.— May, 1831. - 21 



234 QUARTERLY PERISCOPE. 

medicine daring the whole time she was in the hospital. Twelve leeches were 
applied to that part of the epigastrium where there was the greatest pain — the 
left side, and these were repeated every day; and, as soon as they came off, a 
poultice was applied, in order that as much blood as possible might be obtain- 
ed. Besides, a poultice was regularly applied twice a day, so that she had the 
benefit of a constant local warm bath over the stomach. On account, however, 
of her extreme constipation, it was necessary to attend to the state of her 
bowels; such a state could not be healthy, and would certainly exert an influ- 
ence upon the state of the stomach, and therefore she had a daily clyster. Had 
I given her medicine by the mouth, it wOuld have irritated the stomach, have 
increased the inflammation, and might have failed in opening her bowels, in 
consequence of its being sent up again, and not allowed by the organ to pass 
the pylorus. She had a clyster every day, twelve leeches were applied, and 
she was allowed nothing but diluents; milk she could not take; of barley water 
she grew tired, and she was restricted at last to weak beef tea, and of that she 
took but little. By these means, without any deviation whatever — without 
an addition being made to them on the one hand* or there being any cessation 
of them upon the other — though she was only admitted on the 7th of October, so 
debilitated that she could scarcely turn in bed, and lay principally on her back, 
she was discharged perfectly well on the 25th of November, having stayed in 
the house some time in a state of convalescence — about seven weeks in the 
whole. The leeches were applied till they seemed to be exhausting her — till 
the tenderness and the heat were diminished, and then they were discontinued. 
They were applied daily from the 7th of October to the 19th of that month, 
and from that time they were applied every other day till the 26th of October, 
when they were no further required. The clysters were diminished in the 
same proportion — that is to say, for two or three weeks they were employed 
every day, and after that period every other day, and then once or twice a 
week, till the bowels came into a perfectly regular state. Towards the end of 
October, she was so freed from inflammatory symptoms, but yet so debilitated 
and so hungry, that I allowed her meat. She took one mutton chop from the 
26th of October every other day; and from that time she was able to sit up, and 
gradually recovered, and went away expressing the greatest gratitude, saying 
that her life had been saved. I do not know whether that was the case, but 
her disease was cured under the means employed. 

I believe that till of late, the nature of these cases was not sufficiently at- 
tended to. When persons vomited, and complained of a pain in the stomach, 
a great number of practitioners gave aromatics and stimulants of various kinds. 
In France this was undoubtedly the general case until the time of Broussais, a 
celebrated physician now practising there. The treatment consisted in what 
they called antispasmodics. Sometimes not only cases of inflammation of the 
stomach, but of the head and various parts of the abdomen, and sometimes of 
the chest, were thought diseases of debility, and to require stimulants and 
nourishment, and antispasmodics. Stimulants and narcotics of all kinds were 
given. 

But although Broussais must have rendered incalculable benefit to his coun- 
trymen, I do not think that we are indebted to him for a change of practice in 
this country; for it had been previously introduced. I know that when I was 
a student it was the custom to attend to these things, though perhaps not to 
such an extent as at the present day. The state of the abdomen was examined, 
in all abdominal affections, to see whether there was inflammation or not; and 
it was the custom to treat all inflammatory affections of the abdomen by anti- 
phlogistic treatment when I learned the practical part of my profession. Per- 
haps I was particularly fortunate, and enjoyed an advantage over a great many 
of my cotemporaries, in studying under the practice of Dr. James Curry, at 
Guy's Hospital. He had been a practitioner in India; he had practised in the 
navy, and had seen a great deal of the necessity of looking out for inflamma- 
tion, and treating it by antiphlogistic means, general and local. It was his 



Practice of Medicine. 235 

custom in almost every case to turn down the bed-clothes, or put his hand under 
them, and press the abdomen, especially in cases of fever, but in a large num- 
ber of diseases also. I soon saw that he was right; and wherever the patient, 
complained of pain, he took away blood locally. He had a particular idea res- 
pecting" the liver, and therefore he applied cupping-glasses continually to the 
right hypochondrium and epigastrium, where the pain was generally seated. 
There can be no doubt that many of his opinions respecting the seat of inflam- 
mation were absurd; he ascribed all to the liver, and seldom thought of inflam- 
mation of the stomach and intestines. He ascribed almost all the affections of 
the abdomen to the liver. His fault consisted in localizing too much, and in 
speaking, not of the abdomen at large, but of the liver; and there can be no 
doubt that he gave mercury more extensively than was necessary. I believe 
that at that time it was not so much the custom generally to attend to the in- 
flammatory state of the abdomen in fever and other diseases as was the custom 
with him; but those who saw his practice, my fellow students and myself, got 
into the way of attending to it; and I have no doubt that the number who at- 
tended his lectures, (which, of course, was far more than attended his practice,) 
are throughout this country practising successfully through the good instruc- 
tion they derived from him. We saw his errors, but we learned great good; 
and to me, therefore, when I see what the French do, and how their opinions 
are changed in the practice they adopt, there is nothing new. It was perfectly 
familiar to me, and had been for many years; and, in fact, I never read any 
thing of Broussais till very lately; and when he is right — and he is unquestion- 
ably as extravagant in his way as Dr. Curry w T as in his — I cannot say that what 
he advances is new to me, I mean the importance of searching out for abdomi- 
nal inflammation, and treating it as inflammation; at the same time, that it is 
not new to me, is owing to my instruction from Dr. Curry. The French have an 
idea that we are not conversant at all with the frequency of abdominal inflam- 
mation; they do not imagine that so many diseases are treated in this country 
by taking away blood locally and generally. I know that a great many books 
are written in England as well as in France, containing erroneous notions of 
practice; I know that many persons have taken the lead in practice in England 
who have been but bad practitioners, because extent of practice does not show 
a man's knowledge or skill, but merely his assiduity and knowledge of man- 
kind; but notwithstanding that, I am satisfied that in this country there has 
been for many years a large number of practitioners, especially those who stu- 
died at Guy's Hospital, who have been pursuing' their avocations in this rational, 
sound, and, I must add, very successful way. The French read many books 
published in this country, which contain erroneous ideas, and hence they are 
led to fancy that our practice is universally erroneous — that we have no idea of 
inflammation occurring so frequently as they know to be the case; but notwith- 
standing that, I am quite satisfied that in no country is the frequent occurrence 
of inflammation recognised more than in England, nor are diseases treated on 
a more antiphlogistic plan. Although still there may be many practitioners 
who do not practise in this sound rational way, particularly those who say they 
are of the old school, (and, after a time, we are all of the old school, and are 
displaced by those who come after us and know more,) T must think that we 
do consider diseases in this country to be inflammatory as much as is done in 
any other, and we do adopt antiphlogistic treatment to as proper an extent. 

To return to the case of the woman: had the inflammation been seated any 
where besides the stomach, I should have assisted the leeches by the applica- 
tion of medicines; but as that was the part to which all the medicines must 
have been applied, I trusted altogether to the leeches, lest I should irritate the 
organ. For what I know to the contrary, calomel might have passed through 
the stomach without irritating it; but still it might not. I trusted that the in- 
flammation of the stomach, chronic as it was, would give way to the leeches, 
the clysters, and low diet; and I did not think it right to run the risk of dis- 
turbing their operation by any medicine. It is possible that by calomel I might 



236 QUARTERLY PERISCOPE. 

have got her mouth tender, and the inflammation would have been subdued 
much sooner; but still, whether it would have locally irritated the stomach by 
its presence, is a point on which I cannot speak with certainty. The case was 
one of great interest, from the severity with which it showed itself when she 
first came to the hospital — on account of the gradual decline of the symptoms, 
the perseverance in one line of treatment, and the perfect recovery of the wo- 
man before she left us. 

It is common for patients to say that they feel a great sinking — that they 
must have food; and then their friends call upon them, and for the purpose of 
looking amiable, whisper in their ear, "never mind what the doctor says; you 
will be better if you take a glass of wine: come, one glass can't hurt you:" and 
continually have I been sent for, after having taken the utmost trouble in the 
case, and brought it nearly to a conclusion, merely from the circumstance of a 
person having taken a glass or two of wine, and thus brought back all the irri- 
tation of the stomach; and even if they neglect the strict rules of diet too soon — 
if they merely eat meat like other people — it will often bring them back to the 
state in which they were at first. These cases are so common, and it is such a 
common practice for persons to take full diet and aromatic medicines in these 
cases, that I am very anxious that the present case should make an impression 
upon you. 

31. Paralysis Agitans.-~-T\\\s disease is so imperceptible in its approach* that 
the precise periods of its commencement is seldom recollected by the patient. 
A slight sense of weakness, with a proneness to trembling, sometimes in the 
head, but most commonly in the hands or arms, are the first symptoms noticed. 
These affections gradually increase, and, at the period perhaps of twelve 
months from their first being observed, the patient, particularly while walking, 
bends himself forward. Soon after this, his legs suffer similar agitations and 
loss of power with the hands and arms. 

As the disease advances, the limbs become less and less capable of executing 
the dictates of the will, while the unhappy sufferer seldom experiences even a 
few minutes suspension of the tremulous agitation; and should it be stopped 
in one limb, by a sudden change of posture, it soon makes its appearance in 
another. Walking, as it diverts his attention from unpleasant reflections, is a 
mode of exercise to which the patient is in general very partial. Of this tem- 
porary mitigation of suffering, however, he is soon deprived. When he 
attempts to advance, he is thrown on the toes and fore part of his feet, and im- 
pelled, unwillingly, to adopt a running pace; is in danger of falling on his face 
at every step. In the more advanced stage of the disease, the tremulous mo- 
tions of the limbs occur during sleep, and augment in violence until they 
awaken the patient in much agitation and alarm. The power of conveying the 
food to the mouth is impeded, so that he must submit to be fed by others. 
The torpid bowels require stimulating medicine to excite them into action. 
Mechanical aid is often necessary to remove the feces from the rectum. The 
trunk is permanently bowed. Muscular power is diminished. Mastication and 
deglutition are difficult; and the saliva constantly dribbles from the mouth. 
The agitation now becomes more vehement and constant; and when exhausted 
nature seizes a small portion of sleep, its violence is such as to shake the whole 
room. The chin is almost immoveably bent down upon the sternum; the power 
of articulation is lost; the urine and feces are discharged involuntarily ; and coma, 
with slight delirium, closes the scene. 

In a clinical lecture lately delivered by Dr. Elliotson, at St. Thomas's Hos- 
pital, a case of this description is introduced as a hook on which to hang some 
practical and pathological remarks — the case is as follows: — 

"The patient, F. E., is thirty-eight years of age, and has had the disease 
eighteen months. He has been accustomed to drink hard at different periods 
of his life. He is a school-master by profession. It is the right upper extre- 
mity which is now affected; but though the right lower extremity is not in agi- 



Practice of Medicine, 237 

tation, it is occasionally retracted as he walks, experiences solitary catchings, 
though it does not shake. The disease began in the head and tongue, but 
when the right upper extremity was affected, it left the head. This pecu- 
liarity distinguishes the present case, that the tongue is one of the parts that 
were first affected. In general this is not the case, and the tongue is not af- 
fected, after many other parts have suffered severely. The head now shakes 
very slightly only. The affection of the tongue is attended by the following 
very curious result. — Whenever the man attempts to speak, the tongue begins 
to quiver like the tongue of a serpent; presently a confused murmur is heard, 
and then suddenly he brings out his words with extreme rapidity; and such is 
the effort that he cannot stop himself, but repeats the few last words again 
and again. It is a phenomenon analogous to the running which occurs on the 
attempt to walk. He cannot manage the muscles at all, without a violent ef- 
fort, such an effort that his tongue gets, as it were, into a run; the common ex- 
pression of the tongue running, when we describe a person who makes a good 
use of it, is really applicable to this patient. I have written down in the case- 
book, * Before he can speak he makes a confused and inarticulate murmur, 
and then speaks rapidly, slurring his words together, and repeating the last 
words several times. The effort makes the tongue and right upper extremit}- 
shake violently. 5 He sleeps very well, his appetite is good, and in all other 
respects, except this shaking of the body, he is in tolerable health. Sometimes 
after a good night's rest he does not shake at all for a few minutes after waking 
in the morning, but then it is not long before the trembling commences. Any 
excitement or attempt to do any thing at once, greatly increases the tremors, 
but by a strong effort he can at length arrest them for a few moments. The 
only other symptom present is costiveness, (he has but two stools a week,) 
and a pain in the head whenever he is anxious." 

Dr. Elliotson informs us that, in many cases, the disease is controllable by 
art — " it ceases on active treatment." In young persons he has often cured it 
— and, in such cases, there has been great constipation. It has so happened 
that all the people we have seen affected with this complaint, have been ad- 
vanced in life, and therefore our practice has not been so successful as that of 
Dr. Elliotson; yet we have sometimes seen considerable relief produced by 
medicine! One of the patients now under our care, a music-seller on Holborn- 
hill, came under our observation about five months ago, and was then so ill 
that we entertained no hope of doing any good. Regular aperients were pre- 
scribed, together with colchicum and bitters. We heard no more of him till 
within these few weeks, when, being summoned to him, we found him in 
nearly the same state as on our first visit. But we were rather surprised to 
learn that, soon after he commenced the remedies above-mentioned, he got so 
much better that he almost daily went out — sometimes as far as Hampstead. 
This man has an insatiable appetite, and the indulgence of this appetite has, no 
doubt, an injurious effect on the complaint. We shall introduce the following 
remarks of Dr. Elliotson on the treatment. 

"If we can ascertain that there is any fulness in any part of the nervous sys- 
tem, or any inflammation, the treatment should consist in bleeding locally or 
generally, or both — in purging and mercurializing — in employing setons, is- 
sues, moxas, &c. If there be nothing of this kind — if there be no reason to 
suspect fulness, or inflammation — if the patient be not of a plethoric habit, and 
no local pain nor tenderness be felt, then such treatment is, for the most part, 
inefficacious. I would, therefore, not have recourse to treatment of this descrip- 
tion, unless there was a plethoric habit, or evident marks of inflammation, or ful- 
ness in some part of the nervous system; or unless there had been some injury 
the effect of which we should necessarily suppose to be chronic inflammation. 
Almost all nervous diseases, whether convulsive, spasmodic, or paralytic, may 
arise from, or be dependent upon, inflammation or congestion, or upon some 
peculiar state which we do not understand. I know of no mode of distinguish- 
ing these varieties of the disease, except what I have already pointed out. 

21* 



238 QUARTERLY PERISCOPE. 

When we cannot ascertain that the disease has arisen from mechanical injury, 
and there is no local pain or tenderness, or fulness of the system, stimulants, 
tonics, electricity, the shower bath, and various remedies — the operation of 
which, we do not understand — iron, sulphate of zinc, copper, nitrate of silver, 
and in short, all those minerals which belong 1 to a class of remedies, each of 
which do good, and has a peculiar operation on the nervous system, distinct 
from that of narcotics, perfectly inexplicable — often prove efficacious in this, 
and all other convulsive, spasmodic, and paralytic diseases. The present pa- 
tient appears to have been both in the St. George's and Middlesex Hospitals, 
and from what I have learned of his previous treatment, I have directed the 
plan which he is now undergoing. I find that, very rationally and properly, in 
St. George's Hospital he had been cupped and bled frequently; that counter- 
irritation had been produced by means of blisters, so that a copious discharge 
was kept up from the back of the head and neck; and that he had been kept 
on low diet. The plan which it was reasonable to pursue in such a case, 
where the patient was in the prime of life, the habit full, and a blow had oc- 
curred — this general and local antiphlogistic treatment, which is often success- 
ful in nervous diseases, was fully pursued, but in vain. I find likewise, that in 
the Middlesex Hospital, it having been ascertained that these means had 
proved unsuccessful after full trial, stimulants and tonics were administered to 
him — porter, good nourishment, camphor, and various stimulant remedies, and 
although these did not cure him, this mode of treatment was as fully justified 
after the former, as the former was in the first instance. As he ;was of full 
habit, the treatment began with antiphlogistic means, and in failure o£them 
recourse was had to stimulants. Among the various remedies which do good 
in the diversified diseases of the nervous system, I believe the most valuable, 
and at the same time the most safe, is iron. Upon the whole, I have succeeded 
better with that than with any others, though in epilepsy it rarely does good. 
I have been much more successful in the treatment of St. Vitus's dance with 
iron than with any other internal mineral remedies, although their efficacy can- 
not be doubted. It is far less nauseating and griping than copper; it does not 
produce the same inconveniences that arise from arsenic, nor the sickness 
which results from sulphate of zinc, nor does it produce that blackness of skin 
which is the effect of nitrate of silver, and the chance of which makes me al- 
ways unwilling to employ it. Knowing, therefore, the treatment which the 
patient had previously undergone, and hearing from him that he was always 
better the more he was strengthened, I ordered him two drachms of sub-carbo- 
nate of iron three times a day, and a pint of porter at dinner. He is a superior 
sort of man, and very desirous of recovery, and I do not imagine that he would 
deceive me by telling me he was better for invigorating measures, if he were 
not. It is certainly necessary to remedy the state of costiveness under which 
he labours, but I do not suppose that purging w r ould cure his disease, though 
I am perfectly aware that, w r here there is congestion or inflammation, or an ap- 
proach to it, purging frequently does cure patients with various nervous dis- 
orders. But on the whole, I really have been disappointed in the use of pur- 
gative?, though I acknowledge their value in various diseases of the nervous 
system. If there be no reason in this case to suppose congestion or inflamma- 
tion, still the bowels are costive, and that is a state to be remedied, for consti- 
pation must make the disease worse. Under these circumstances, I have or- 
dered him to take half a minim of croton oil daily, in order to keep his bowels 
freely open; for though purging him may do him no good, and by debilitating 
would probably make him worse, yet constipation will be sure to do him harm. 
There is another reason also why costiveness should be obviated; — the iron 
would be liable to accumulate in the alimentary canal. The carbonate is a 
bulky remedy, and if any deficiency of the alvine discharge occurs, it will, of 
course, accumulate. I usually administer it in treacle, because treacle has a 
tendency to keep the bowels open." 

Dr. Elliotson cautions us against confounding paralysis agitans with the tre- 



Practice of Medicine. 239 

mulous agitation of drunkards. The latter generally affects both hands, and 
commences or increases on any muscular effort. In paralysis agitans, the cir- 
cumstances are just the reverse — a strong effort will, for a few moments, sus- 
pend the tremor. — Med. Chirurg. Rev. Jan. 1831, and Lond. Med. Gaz. Oct. 
1830. 

32. Chloride of Lime in Pectoral Disease, with great Foetor of breath and Ex- 
pectoration. — Drs. Graves and Stokes have administered the chloride of lime in 
a case of pectoral disease, with great fetor of breath and expectoration, with 
remarkable benefit. The patient, in consequence of exposure, was attacked 
with pain in his side, and other symptoms of inflammation of the lungs, fol- 
lowed in a tew days by fetid breath and expectoration, extreme debility, hec- 
tic fever, cough, &c. A pill of three grains of chloride of lime, with one of 
opium was given three times a day, and the quantity increased to twelve grains 
a day. The bed was also sprinkled with a solution of the salt. The most rapid 
and marked amendment followed — the fetor of the breath and expectoration 
disappearing in a few days. The remedy was omitted, the fetor returned, and 
was again checked by resuming the use of the remedy. — Dublin Hospital Re- 
ports, Vol. V. 

33. Delirium Tremens. — Professor Sferanza, of Parma, in his clinical report 
for 1823-4, states that he treats this disease successfully by bleeding, leeches 
to the head and anus; jalap, calomel, prussic acid, and application of ice to the 
head. He prefers of the various names given to this disease that proposed by 
J. Frank, viz. encephalitis trernefaciens. — Bull, des Sc. Med. Sept. 1830. 

34. Catalepsy accidentally cured. — Two cases of this kind are related in the 
Annali Universali di Med. for October, 1830. The first occurred in a girl, ten 
years of age, who had been cataleptic for several months. The paroxysms in- 
creased in frequency; various remedies were employed in vain, when during 
an attack she struck her # head violently against a stone, which produced a flow 
of blood, which not only relieved the paroxysm, but also produced a complete 
cure of the disease. 

The second case was a young farmer, of a melancholic temperament, of about 
twenty years of age, who, after continued trouble, was attacked with catalepsy, 
sometimes accompanied with delirium and somnambulism. Bleeding, leeches, 
baths, blisters, emetics, &c. were employed in vain, when a copious epistaxis 
spontaneously occurred about the thirteenth month of the disease, which was 
followed by a complete disappearance of the affection. 

35. Chloride of Lime in Gonorrhoea. — Dr. Edward Graefe, of Berlin, has de- 
tailed five cases of gonorrhoea in which the chloride of lime was employed with 
much advantage. The first was a stout robust man, aged twenty-six years. He 
was first directed to take a table-spoonful, every two hours, of a solution of 
nitre in almond emulsion, of the strength of«gj. tq^viij. This had the effect 
of allaying the burning and chordee. He was then put upon the following- 
mixture: — f£. chloride of lime, £j.; almond emulsion, ^vij.; syrup of gum, |jj. M. 
A table-spoonful to be taken every three hours. After taking two or three 
doses of the medicine, the patient experienced painful erections, burning in 
the course of the urethra, and pain in voiding urine. All these symptoms, 
however, were much abated before the whole of the mixture was taken, and 
the discharge was mucfc diminished in quantity. The same medicine was re- 
peated, and with the effect of producing the same symptoms that we have 
enumerated above, but in a less degree. A third portion of the same mixture 
completed the cure. 

The second case was that of a robust individual, aged about twenty-four 
years, who had been labouring under the disease for several weeks. After 
using 5J. of nitre in the almond emulsion, as above, he was put upon the use 



240 QUARTERLY PERISCOPE. 

of the chloride of lime, s;j. to ^viij. of the almond emulsion. After taking six 
doses of the medicine, the patient experienced a burning and pricking sensa- 
tion in the urethra, a soreness along the course of the penis, with difficulty of 
voiding urine. On the fourth day, the same symptoms continuing, giss. of the 
tinct. opii was added to the mixture, with a view of allaying the irritation, 
which was supposed to arise from the chloride. On the next morning, the 
symptoms had abated, and the discharge was diminished in quantity. On the 
eighth day, he was ordered chloride of lime, giss. ; almond emulsion, ^viij.; 
tinct. of opii, giss.; syrup of opium, §j. A table -spoonful to be taken every 
three hours. In a few days he was entirely cured. 

The two next cases were treated in nearly the same manner, with the excep- 
tion that the quantity of the tinct. opii was reduced to a scruple. The fifth 
case was that of an individual who had been afflicted about six months with 
the consequences of gonorrhoea. He was put upon the use of the following 
mixture: — R. chloride of lime, £iss.; tinct. opii, gj.; almond emulsion, ^viij.; 
syrup of opium, §j. A table-spoonful every three hours. The patient took 
three portions of this medicine, without exciting the unpleasant symptoms 
mentioned above; but it did not overcome the disease. A fourth portion was 
directed, with the addition of an injection composed of gj. of the chloride of lime, 
the same quantity of tinct. of opium, andgviij. distilled water, to be employed 
morning and evening. The patient experienced slight burning and pricking 
in the urethra; this, however, was only temporary. Finding, after using a 
second portion of the injection, that some symptoms of the disease still con- 
tinued, he was directed to take the following pills: — R. bals. copaiva, gij. ; 
calomel, gr. v.; cubebs, q. s. to make into pills of two grains each, of which 
six were to be taken three times a day. By this course the patient was entirely 
cured, and experienced no return of his disease. — Journal fur Chirurgie und 
Angenheilkunde, Band. XIV. Stuck. 2. 

36. Tetanus and Neuralgia Treated by the External Application of the Acetate 
of Morphium. — Dr. Gaspabd Cerioli reports two case's, one of traumatic teta- 
nus, the other of neuralgia, which were successfully treated by the application 
of morphium to a blistered surface. In the first, a quarter of a grain of mor- 
phium was applied to the neck, the skin having been previously denuded of 
the epidermis by a blister. This was repeated twice during the first day, and 
was afterwards increased to one-third of a grain. A long-continued and obsti- 
nate neuralgia of the face was cured by a similar course. A case is also reported 
of a distressing irritation in the larynx, which prevented the person from sleep- 
ing, by keeping up a constant cough, and which seemed to threaten the de- 
velopment of laryngeal phthisis. It was speedily removed by use of morphium 
as in the above instances. — Hecker Litterarische Annalen der Gesammten Heil- 
kunde, June, 1830. 

37. Sulphuret of Potassa in Croup. — Dr. Fritze, of Magdeburg, speaks in 
very favourable terms of th^e sulphuret of potassa, or liver of sulphur in the 
treatment of croup. The patient is first to have one enema of vinegar and 
water, the strength of which must be varied to suit the age of the child. A tea- 
spoonful of the following mixture is then to be administered every hour, or 
every half hour, according to the urgency of the case: — R. kali sulphuret, gr. 
xij.; pulv. sacchar. alb. ^j.; aquae napthse, ^ss., M. S. A. The child must 
only be allowed mucilaginous drinks, and should have the throat, anterior part 
of the neck and chest rubbed with half a tea-spoonful 9/ the following liniment 
every hour: — JJ. unguent, hydrarg. ciner. liniment, ammoniat, aa. §ss. M. 
ft. liniment. In most cases, in the course of a few hours, the cough becomes 
looser, with a free expectoration of mucus, and shreds of false membrane: the 
respiration less embarrassed, and free operations take place by stool. — Hufeland 
and Osann's Journ. fur Pract. Heilkunde, B. 70, Stuck. 1. 



Practice of Medicine. 241 

38. A Case of Involuntary Contractions of the Muscles Cured by the Employ- 
ment of the Hydrocyanate of Zinc. — A female, aged thirty-six years, of a ner- 
vous temperament, had been affected for twelve years, with an irregular in- 
voluntary contraction of the muscles of the lower extremities, brought on by a 
severe fright. After several remedies had been employed without success, Dr. 
Klokow prescribed for her the hydrocyanate of zinc, in doses of one-tenth of a 
grain, with a large quantity of mucilage. She was also directed to take quassia and 
valerian at the same time. At first the medicine could not be given in larger 
doses without exciting violent colic, vomiting, and diarrhoea. In proportion, 
however, as the system accommodated itself to the remedy, the dose was in- 
creased to half a grain. So beneficial was the result, that towards the close 
of the year the patient was able to leave the house, which she had not done 
during the preceding twelve months. — Huf eland and Osanii's Journ. fur Pract. 
Heilkunde, B. 70, Stuck. 2. 

39. Perforation of the Stomach. — A child, who had been hitherto healthy, was 
seized with a dry, convulsive, asthmatic cough, followed, in the course of a 
few weeks, by an attack of hydrocephalus, which terminated fatally. On exa- 
mination of the body, in addition to the other lesions which existed, a large 
perforation was observed, occupying the fundus of the stomach. — Huf eland and 
Osann Biblioihek, der Practischen Heilkunde, B. 63, Stuck. 5. 

40. Nitro-muriatic Pediluvise in Engorgements of the Liver and Spleen. — Dr. 
Tastnini, of Pisa, has employed the nitro-muriatic pediluvio;, as some years ago 
recommended by Scott, with success in some cases of engorgement of the 
liver. He makes the bath by adding six ounces of water, three ounces of mu- 
riatic, and two ounces of nitric acid, to five gallons of warm water. For some 
weeks the pediluvium is used every night, and afterwards every other night. 
The feet are kept in the bath from twenty to forty-five minutes. 

Dr. Brwo Spadafora, of Sersale, in Calabria, says that this remedy is equally 
useful in engorgements of the spleen, especially those which succeed to inter- 
mittent fevers. — Gazette Medicate, Feb. 1831, from the Osservat. Med. 

41. Treatment of Epilepsy by repeated doses of Ipecacuanha. — Dr. Fmirara, 
of Naples, has successfully treated a young lawyer who was attacked with 
epilepsy, by the administration of four or five grains of ipecacuanha every 
morning, and the same dose whenever any premonitory symptoms of the dis- 
ease appeared. 

Dr. Gaetano Allegretti, another Italian physician, induced by the success of 
the remedy in this case, has had recourse to it in four instances, in three of 
which he says a cure was effected. — Ibid. 

I 42. Treatment of Scrofula with Iodine. — At a meeting of the Academy of 
Sciences of Paris, on the 3d of January last, M. Majendie made a report on 
the treatment of scrofulous diseases at the Hopital St. Louis, by the prepara- 
tions of iodine. In a preceding volume, (Vol. VI.) we gave a very full account 
of M. Lugol's method of employing the iodine for the cure of scrofula, and 
noticed the success which had so far attended the use of that remedy. A com- 
mittee was appointed by the Academy to verify by new facts the results first 
obtained. This committee state in their report, as we learn from an abstract 
in a late No. of the Gazette Medicale de Paris, that the recent success of which 
they have been witness do not leave any doubt of the complete efficacy of the 
preparations of iodine in the treatment of scrofula. They say that it has 
not only succeeded in the early, but that it has effected cures in the most 
advanced stages, where there were great alterations of the glands and other 
organs, serious lesions of the bones and principal articulations, accompanied 
with general affections, which announce an approaching fatal termination of 
the disease. 



242 QUARTERLY PERISCOPE. 

A number of very striking cases are related by the committee, one of which 
we shall notice. It is that of a postillion, twenty-four years of age, who was put 
under treatment in a state of colliquation, which was regarded beyond the re- 
sources of art, and M. Lugol had admitted him into his wards, only to contribute 
to the anatomical history of scrofula. 

The case was one of cutaneous scrofula, which occupied both arms and 
shoulders, and both legs; the muscles were denuded and reduced to a state of 
extreme tenuity. There was copious suppuration; for twelve years upwards 
of a pint of pus had been discharged daily; for eighteen months he had had 
colliquative diarrhoea; there was the last degree of marasmus; the patient was 
feeble, stunted, and appeared only ten years of age. This patient was cured 
by the ioduretted treatment in six months; and the committee were struck as 
much with the beauty and firmness of the cicatrices as with their vast extent. 

The method of M. Lugol does not solely differ from that of other practitioners 
in the use of iodine; all his patients use exercise. Thus patients affected with 
white swellings of the foot, knee, hip joint, and other articulations,, are not 
kept in bed, but walk daily. Thus a young man who had extensive caries of 
the metatarsal bones, and who had been kept in bed for four months in the 
surgical wards, was transferred to those of M. Lugol, who treated him by or- 
dering him to walk every day. The patient was cured after a number of pieces 
of the metatarsal bones came away. The reporter concludes by bestowing the 
greatest praises on M. Lugol. 

43. Hydrophobia successfully Treated. — At a meeting of the Academy of Me- 
dicine, on the 18th of January last, M. Boisseau made a report on a case of 
hydrophobia, communicated by M. Ozanam, of Lyons, and which was success- 
fully treated. The patient had been bit in the leg by a mad dog. On the fif- 
teenth day the wound had cicatrized — on the twenty -fifth the consecutive symp- 
toms appeared: as moroseness, loss of appetite, insomnia, furious delirium,, 
flushed face, cries of affright, &c. M. Ozanam bled the patient about three 
pints, and applied caustic potash to each side of the larynx — ice to the head; a 
powder composed of musk, sulphuretted oxide of antimony, muriate of am- 
monia, and sugar in small doses every half hour; and enemata of valerian and 
laudanum. The symptoms appeared to abate, and caustic potash was then ap- 
plied to the cicatrix. The same treatment was continued for four days, and at 
the same time leeches were applied to the mastoid apophyses. The amend- 
ment continued, and on the thirty-fifth day the patient was discharged cured. 
M. O. considers hydrophobia as an inflammatory spasmodic affection. — Gazette 
Midicah, Jan. 1831. 

44. Savine as a remedy in Chronic Passive Uterine Haemorrhages. — Dr. Feist* 
in a communication in the Gemeinsame Deutsche Zeischift fur Geburtskunde. 
Vol. IV. states that he has derived great advantage from the use of savine in 
uterine hemorrhages, which have continued for a long time, and when the dis- 
charge was thin, pale, and foetid. He uses the remedy according to the fol- 
lowing formula: — R. Powdered savine leaves, giij.; extract of savin, ^ij.; dis- 
tilled oil of savin, 9j. mix and divide into pills of three grains each. Four of 
these are to be taken three times a-day at first, and the number gradually in- 
creased until ten are taken at each dose. The credit of being the first to call 
the attention of practitioners to the use of this article in metrorrhagias, is award- 
ed to Dr. Wedekind.— Rev. Med. Oct. 1830. 

45. Efficacy of Hydrocyanic Acid in curing Vomiting not dependent upon In- 
Jiammation. — We extract from a clinical lecture by Dr. Elliotson, reported in 
a late number of the London Medical Gazette, the following remarks on the 
efficiency of hydrocyanic acid as a means of arresting vomiting. It should first 
be ascertained, says Dr. E. whether there is inflammation or not; for if there be 
inflammation, the hydrocyanic acid would not cure it; the case must be treated 



Practice of Medicine. 243 

like inflammation of any other part of the body. But if you can find no inflam- 
mation whatever, and you find no cause for vomiting in any other parts of the 
body, (it will often arise from an irritation in the intestines, the kidney, the 
womb, and ten thousand distant causes,) then the hydrocyanic acid will relieve 
the vomiting 1 far more, I am satisfied, than any other medicine. I have not 
found it relieve the pain of rheumatism or cancer, or pain situated in any of the 
distant parts of the body, or pain in the intestines; it is of no use in colic., 
though it is said by some to be of occasional service in neuralgia. As an anodyne 
I have not found it of the least use in general, except in cases of pain of the 
stomach. It has the properties of an anoydne on the stomach particularly, and 
has a tendency to lessen the morbid irritability which produces vomiting. It is 
no exaggeration when I state that I have frequently seen vomiting, which has 
lasted for months, cease on the exhibition of the first dose of this medicine. 
Frequently, however, in cases of spasmodic pain of the stomach, you will find 
that the first dose, or the second, or even one week's exhibition, will not answer 
the desired end: you will be much more struck with its use in lessening vomit- 
ing than in lessening pain in the stomach. But you will find it of no service 
unless you make a distinction between the existence of inflammation, and the 
influence of distant causes, on the one hand, and mere morbid irritability of the 
stomach itself upon the other. 

Hydrocyanic acid is a medicine that is exceedingly powerful, and you cannot 
give it in the same dose when the stomach is empty as when it is full. When 
the stomach is full the difference of a drop may cause a great difference in the 
effects. Supposing you are giving three drops, three times a day after meals, 
it certainly will not be right to give more than one or two drops upon an empty 
stomach. To avoid any confusion which may arise, it is best always to give it 
after meals, otherwise you must vary the doses at different times of the day. 
You cannot, in general, give it on an empty stomach more than once in the day, 
because when food has been once taken, the second meal comes usually before 
the stomach is as empty as it was before. On this account I make it a rule to 
give it after breakfast, in the afternoon, and the last thing at night. As it is so 
powerful, you cannot tell before hand the dose that will be borne, and you 
should begin with a small quantity, such as you know can hardly disagree with 
the stomach. I begin with one minim, though you may begin with two, and 
many persons do so, but it is safer to begin with one. I give one minim three 
times a day, diluted with water, or aromatic water; and in the course of a day, 
if no unpleasant effect be produced, I increase the dose to two minims, and the 
third or fourth day I give three minims, and so on till it produces the effect I 
desire, or some inconvenience arises. Although it will relieve the vomiting 
arising from mere morbid irritability, it will, from its irritating properties, like- 
wise cause it. If you give an over dose, it may produce extreme nausea, ex- 
treme vomiting, and perhaps gastrodynia — pain in the stomach. It is common 
for many narcotics to be stimulating as well as sedative, and this is the case 
with this medicine; and medicines act with different power upon different peo- 
ple; and therefore you should give it in -small doses at first, if you wish to make 
it act favourably. Tobacco will arrest the action of the heart, and cause com- 
plete prostration of strength, and yet it excites sneezing, and one person is af- 
fected by a quantity not noticed by another. In general people bear from two 
to four minims, but you not unfrequently meet with individuals with whom five 
minims do not disagree, and now and then you may safely increase the dose to 
six or eight, or even more. 

You will find this of great use for another purpose — for making other medi- 
cines sit upon the stomach, which would otherwise disagree with it. You may 
lessen the natural irritability of the stomach so much, that iodine, colchicum, 
and medicines of that active description, will frequently sit upon it, whereas 
they would not unless ten minutes before you administered them you gave a 
dose of hydrocyanic acid. These medicines may remain upon the stomach if 
you unite prussic acid with them, but it answers better for this purpose if given 
ten misutes before, so as to come into full operation before the acrid medicines 



244 QUARTERLY PERISCOPE. 

are taken. In organic affections of the stomach, you will frequently find it an- 
swer better than any other medicine? if there be cancer of the stomach, scirrhus, 
pylorus, or whatever the organic disease may be, you will often find the hydro- 
cyanic acid allay the vomiting- and pain much more than any thing- else. 



OPHTHALMOLOGY. 

46. Purulent Ophthalmia treated with Iodine. — M. Majendie in his report to 
the Academy of Sciences, relative to the treatment of scrofula by iodine, re- 
lates his having- seen in the Hopital St. Louis, under the care of M. Lugol, a 
case of purulent ophthalmia cured by the employment of ioduretted collyria 
and injections, with the internal use of iodine. The state of the eyes in this 
young- patient would be difficult to describe; they were hypertrophied to the 
utmost degree; they had lost their form, and the pus gushed out in a continued 
jet, like the most copious Menorrhagia. After the fourth days 5 employment 
of the iodine, an amendment was perceived, and in a month he was cured. — 
Gazette Medicate, Jan. 1831. 

47. Cataract cured by the Juice of the Anagallis Phenicofiora — M. Ozaxam has 
communicated to the Academy of Medicine, a case of cataract cured in forty 
days by means of lotions to the cataractous eye of the juice of the Anagallis 
phenicofiora, extracted in the month of September. The detail of this case is 
however, very imperfect. 

48. Cases of Amaurosis successfully treated. — Dr. Buzzi has communicated to 
the Medical Societ}' of Florence, five cases of amaurosis successfully treated. 
From the account of these cases in the Annali Universali di Medicina, July, 1829, 
it appears that in the two first cases, (a man and a woman,) the disease was 
caused by a bilio-gastric affection. They were cured by purgatives, but prin- 
cipally by repeated emetics, as advised by Cotugno, and successfully used 
by Stevenson. The vapour of ammoniacal ether was also directed to the eye. 
The treatment was entirely successful. 

In the third case the disease was produced by excesses in the use of spirituous 
liquors; the patient was treated first by emetics, afterwards by emetized drinks; 
rigid diet; diluent drinks; wine and water, and repose. 

The fourth case was occasioned by masturbation. It ceased on the abandon- 
ment of this vicious habit, the moderate use of good wine and a milk diet. 

The fifth case was successfully treated by anthelmintics, the affection ap- 
pearing to depend on the presence of worms in the intestinal canal. 

49. Inflammation of the Ciliary Ring. — Dr. Ammon, in the thirty -third volume 
of Bust's Magazin, states that the ciliary ring is sometimes primarily affected 
with inflammation. The disease, he says, is ushered in by occasional shooting 
pain in the ball, and involuntary winking. A fasciculus of red vessels just be- 
hind the cornea next appears, like the red ring in iritis, but not extending all 
round the cornea, as in the latter disease; subsequently the inflammation extends 
to the membrane of the aqueous humour, and to the iris when the usual symp- 
toms of these diseases make their appearance. Staphyloma sclerotica? is also, 
according to Dr. A. one of the consequences of inflammation of the ciliary 
ring. Scrofulous and rheumatic persons are said to be most liable to this dis- 
ease. It is usually excited by exposure to cold. The disease is treated by Dr. 
A. at first by antiphlogistics, and afterwards by the internal use of the follow- 
ing: — B> terra;, pond, salitx, gj.; aq. laurocerasi, ^j.; 11 to 40 from three to 
six times a day. Also the application of linen compresses, or a flaxseed poul- 
tice with belladonna to the eye. 

It does not strike us that the author has very clearly made out the existence of 
the inflammation of the ciliary ring as a primary disease, or at least pointed out 



Surgery. 245 

any signs from which a diagnosis may be drawn, but it has appeared worth 
while to notice the subject, that the facts may be determined by such as have 
opportunities for that purpose. 



SURGERY. 

50. Laryngotomy successfully performed in a Female affected with a large. 
Goitre. — The operation of laryngotomy has recently been successfully per- 
formed by M. Willaume, chief Surgeon of the Military Hospital of Metz. 
The subject of the operation was a female, aged twenty-eight, affected with 
a large goitre, in whom a fragment of bone had passed into the trachea, when 
swallowing some broth. AH the usual measures for the removal of this foreign 
body having proved fruitless, and suffocation being threatened, laryngotomy 
was performed, and the bone was discharged by a violent effort to cough. The 
wound promptly cicatrized, and the voice was not in the least changed. — 
Compte rendu des travaux de la Soc. Med, du depart, de la Moselle. 

51. Internal Strangulation. — Dr. Lakussac relates in the Giornale Paiologico- 
medico Chirurgico di Palerma, for May, 1830, a case in which a portion of the 
arch of the colon passed through a preternatural opening in the diaphragm 
into the thorax, producing a fatal strangulation. Several similar cases are on 
record.— Revue M^d. Dec. 1830. 

52. Radical cure of Hernia. — "We find in the Gazette Medicale de Paris, for 
July last, a report by M. Breschet to the Academy of Medicine, on two me- 
moirs by Dr. Ravin, of St. Vallery-sur-Somme, on the radical cure of hernia. 
This method is only applicable to recent and small, or better to old and large 
hernias, in which there are no adhesions between the sac and the contained 
parts, and in which the latter is perfectly reducible. The method consists in 
reducing the hernia, and keeping the part which protruded as long as possible 
at a distance from the canal, so as to allow of the slow contraction of the apo- 
neurosis, dilated by the protrusion of the intestine, which contraction, M. R. 
says, will take place when no mechanical obstacle is opposed. The method of 
M. R. requires that the patient should be placed upon his back, the pelvis 
raised higher than the diaphragm, and the side on which the hernia is situated 
higher than the sound. A bandage must be placed over the orifice of the ring, 
and compresses, either dry or moistened with tonic and astringent lotions, 
placed between the cushion of the bandage and the inguinal ring; the most 
absolute rest is also necessary. M. R. relates eight cases cured by these means. 
The cases occurred in persons of different ages, and both sexes. Thus one 
was a man, aged twenty-six, with a recent and small inguinal hernia — he was 
cured in twenty-six days. Another, a woman, aged sixty, affected with hernia 
for upwards of twenty years, was cured in six months. The ordinary duration 
of treatment, however, has been two months. M. R. requires his patients to 
wear a bandage for some time after their cure, but he has never seen a relapse 
except when the patient has not continued in a recumbent posture during the 
whole course of the treatment. 

The reporter speaks favourably of the candour with which the memoirs are 
written, and the evident desire of the author to relate the truth, and to advance 
science. The treatment is safe and worthy of trial. 

M. Dublas, of Lyons, has also communicated to the Academy of Lyons, a 
memoir on the radical cure of hernia; the method proposed by him is: — diet, 
repose, recumbency on the back, and astringent applications upon the hernia. 
The Gazette Medicale, to which we are indebted for this notice, does not fur- 
nish us with further details. 

No. XV.— May, 1831. 22 



246 QUARTERLY PERISCOPE. 

53. New Method for the cure of Hernia. — M. Belmas has communicated to the 
Institute a method for the cure of hernia, proposed by himself, and which is 
thus described in the Journal des Progres, Vol. III. 1830. If a gold beater's 
skin filled with air, be introduced into the abdominal cavity of a dog, it excites 
around it, but merely to an extent corresponding with its size, an inflammatory 
irritation, followed by a lymphatic deposition, an absorption of air, and also of 
the bag itself; so that at the expiration.of some days, a concrete albuminous 
mass can alone be found, and after some weeks only a fibrous knot remains. 
Similar experiments made by M. Belmas on the hernial sac of dogs have been 
followed with the same result as in the abdominal cavity. Filled with the dis- 
tended bag, the sac inflames through all its extent, and is obliterated in a few 
days in the manner above-mentioned, without preserving any remains of the 
foreign body introduced. Of thirty female dogs affected with hernia, which 
have thus been operated on, in spite of the indocility of these animals, thirteen 
have been radically cured. M. Belmas operates in the following manner: — A 
small bag of gold beater's skin, perfectly empty, is connected with a tube fur- 
nished with a stop-cock. A small incision is made with a short, and narrow 
bistoury at the most inferior part of the hernial sac, the edges of which are 
drawn asunder, and there is introduced into the sac a cannula and stilette,tothe 
extremity of which the tube of the bag is fitted. The point of the cannula is 
pushed with suitable precautions to the superior part of the sac, near the neck. 
The stilette is then protruded, and through the opening which it makes in the 
skin, the cannula and the tube of the bag are to be drawn out. To this tube is 
to be attached that of another bag filled with air; the stop-cock of the first is to 
be opened, and a sufficient quantity of air is injected into the bag of gold 
beater's skin, and there retained by closing the cock. The operation has al- 
ready been practised on a man, and with complete success, notwithstanding 
unfavourable circumstances^ such as the advanced age of the patient, his ca- 
chectic constitution, a paralysis of the bladder, and a chronic catarrh. Much 
swelling succeeded on the second day, and M. Belmas dreaded some unpleasant 
consequences, but none occurred. For two months and a half there has been 
no return of the hernia, although the patient is the subject of an habitual 
cough. This man has been presented at the clinique of the Hotel Dieu. 

It should be remarked, that the bag should be introduced in a dry state into 
the sac. M. Belmas who at first thought it most convenient to cover it with 
oil, discovered that this alone was sufficient to prevent its absorption. 

54. Lithotrity. — Some time since the general administration of the hospitals 
of Paris gave to M. Civiale the charge of a ward in the Hospital Neckar, 
which was assigned for the treatment of calculous patients by lithotrity. In a 
report lately made to the Academy of Sciences, and which we find in a late 
number of the Gazette Medicate de Paris, M. Civiale states that within the 
space of six months sixteen patients were admitted into his ward: seven of 
these were operated upon by lithotrity, four by lithotomy, and the five others 
were not in a condition to undergo any operation. 

The first case operated upon by M. C. was a young man; the calculus was 
friable, and filled the cavity of the bladder almost entirely, so that it was difficult 
to inject into that organ a few spoonfuls of water. The patient was cured. 
The calculus in the second patient was small, but there was stricture of the 
urethra, which it was necessary first to destroy — great tumefaction of the prostate, 
and catarrhus vesicae. These circumstances would have rendered the operation 
impracticable had the calculus been large; being but small, it was completely de- 
stroyed in ten minutes. The third patient was a man of almost eighty years of 
age, much worn down by acute and long-continued sufferings. The stone was 
as large as a pullet's egg. The patient supported the operation well, notwith- 
standing his advanced age. The fourth patient was sixty years of age, and sc 
irritable that the introduction of a bougie into the urethra produced convulsive 



Surgery 241 

actions. The irritability was diminished by the repeated introduction of bougies 
and an appropriate medical treatment, and in four sittings of some minutes each 
the calculus, (an uric acid one,) which was of the size of a small nut and very hard, 
was destroyed. The fifth case was that of an old man, exhausted by pain and 
the great alteration of the genito-urinary organs. The bladder was the seat of 
catarrh, and contained a great number of calculi, requiring many sittings for 
their destruction. The other two cases do not offer any thing very remarkable 
in their details, except that in the one the patient had learned to arrest the 
evacuation of his urine before the bladder was completely emptied, and thus 
preserved himself from the pain commonly suffered by calculous persons when 
the bladder contracts upon the stone; and the other is interesting as showing 
the little influence which the operation exerts in general upon other coexisting 
organic lesions. 

M. Civiale states that he has himself operated upon one hundred and fifty- 
two patients, but he does not communicate the proportion cured. 

55. Section of the Sciatic Nerve. — This operation has been performed by Dr. Ma- 
iagodi, of Bologna, for tl^ cure of an obstinate neuralgia, seated in the super- 
ficial nervous ramifications of the leg and foot of eleven years duration, and 
which had resisted a multitude of remedies. Previous to the operation, Dr. M. 
tried a number of experiments upon dogs, from which it appeared that the sec- 
tion of the sciatic nerve, two-thirds dov/n the thigh, produces paralysis, and 
subsequently atrophy, but not gangrene. That this paralysis extends from 
the middle of the leg to the extremities of the toes — that the leg does not, 
however, lose the power of sustaining the body, or become unfit for the pur- 
poses of locomotion, the muscles which move it not being paralysed, and the 
knee joint not being affected. It is also proved by amputations of the thigh, 
that the division of the nerve does not compromise life. These results deter- 
mined Dr. M. to perform the operation, which he accordingly did on the fifth 
of March, 1828, in the presence of Professors Matheo Venturoli, Paolo Baroni, 
and M. Joseph Bertolotti. The patient was a man aged thirty-one years. The 
Incision was made about three inches above the popliteal hollow, and was two 
inches and a half in extent. At the moment when the section of the nerve at 
the upper part of the wound was made, there occurred a trembling of all the 
limbs, and a pain similar to the pricking of needles rapidly extended from the 
place of section to the spinal column and brain, and the patient fainted. When 
he recovered, which was very soon, Dr. M. requested him to be very attentive 
to his feelings, and the nerve was then divided at the lower portion of the 
wound, without the patient being aware of it. Upwards of two inches of the 
nerve was thus removed in order to prevent its reunion. From the moment of 
the division of the nerve, all pain ceased, and had not returned five months af- 
ter, when Dr. M. communicated the case to the Medico-Chirurgical Society of 
Bologna. There was paralysis however of the leg and foot, with tingling and 
sensation of weight in these parts, but there remained an obtuse sensibilitv of 
the inside of the leg.— Gaz. Med. Feb. 1831, from the Osservat. Med. XXIII. 

56. Wound of the Pericardium and Heart. — M. Larret exhibited to the Aca- 
demy of Sciences, at their meeting on the 12th of December last, a soldier who 
had been wounded by a ball, which passed through the chest, entering two or 
three lines from the left nipple and passing out between the spine and the sca- 
pula half an inch from its inferior angle. It is supposed that the ball passed 
through the pericardium, a portion of the left lung, and furrowed the surface 
of the heart. There was at the moment of the accident extreme prostration, 
with all the symptoms which characterize these lesions. It was expected for 
the first forty-eight hours that he would expire every moment. By appropriate 
means he was recalled to life, and the cure was complete. — Gazette Medicale, 
December. 1>830. 



248 QUARTERLY PERISCOPE. 



MIDWIFERY. 



57. Vagitus Uterinus. — M. Battdelocq.tte has communicated to the Academy 
of Sciences a case of labour, in which the waters being" evacuated, the face of 
the child presented to the neck of the uterus, and the child uttered cries as 
strong as if it had been delivered. This and some analogous facts prove, ac- 
cording to M. Baudelocque, that it is important to introduce air within the 
membranes, as he has proposed when the child is in danger of perishing. — 
Journal Uhiversel et Hebdomadaire, Tom. I. No. 11. 

58. New symptom of Pregnancy previously to the Fourth Month. — It is well 
known how uncertain the signs of pregnancy are, previously to the fourth 
month. Dr. Beccaria announces in the JLnnali Universali di Med. for Septem- 
ber last, that he has discovered a symptom by which it may be determined: 
this is a very acute pulsating pain in the occipital region, occupying particu- 
larly the part in which Gall locates the organ of the instinct of reproduction. 
This pain, Dr. B. says, is accompanied with giddiness on the least motion of 
the head, and with difficulty in supporting the light. This pain comes on 
suddenly, without any premonition; it continues for some time; an inclination 
to sleep succeeds, and after sleeping some minutes, the patient awakes com- 
pletely free from the pain, and with a strong desire for food. These pains re- 
appear daily, at nearly the same hour, for about eight days; they afterwards 
disappear spontaneously, without any remedy employed to remove them earlier. 
This symptom, Dr. B. says, commonly manifests itself, unaccompanied with 
the signs usually laid down as denoting pregnancy previously to the fourth 
month. Dr. B. asserts that he has observed this symptom in women who were 
not aware of being pregnanl, and even did not suspect the fact. 

Should the assertion of Dr. Beccaria prove true, it will not only be highly 
important in a medico-legal point of view, but extremely interesting in a phy- 
siological one. 

59. Cesarean Operation, by which both Mother and Child were saved. — A case 
is reported by Dr. Fr. Johankitecht in JLbhandlungen und Beobachtungen der 
Jlrztlichen Gesellschaft zu Minister, in which, by the Cesarean operation the 
lives of both the mother and child were preserved, although many of the cir- 
cumstances under which it was performed were highly unfavourable. Another 
case is also reported, by the same, in which the life of the mother was lost, but 
the child was preserved. — -Huf eland and Osami's Journ. fur Pract. Heilkunde, 
Band. 70, Stuck. 2. 

60. A case in which the Fragments of a Child were discharged per anum. — A 
widoM' woman, aged forty years, applied to Dr. Boogaard, in October, 1819, 
complaining of great weakness, induced by a troublesome diarrhoea. She was 
much enfeebled, her ankles oedematous and her general aspect leucophlegma- 
tic. Dr. B. ordered for her involventia diuretica amara, from which she seemed 
to be somewhat relieved, in the course of a fortnight. In the spring of 1820, 
the diarrhoea again became troublesome, and she remained under the care of 
her physician throughout the year. In 1821, it was attended with fever and 
loss of appetite, and in her discharges were discovered some fragments of the 
bones of the cranium of a matured foetus. She stated that she had been married 
seventeen years, had borne four living children, and had aborted three times. 
She had been a widow three years and a half, but for three years before had not 
menstruated, and from this circumstance supposed she was pregnant. During 
the first four months of this period, her health did not suffer, subsequently, 
however, the left side of the abdomen became tumid, she felt uncomfortable 
and suffered much from pain in the loins, and a bearing down sensation. She 
could not lay on the left side without pain, but the abdomen was not painful to 



Medical Jurisprudence. 249 

the touch. She was sensible of slight motion. About the seventh or eighth 
month she experienced severe pain, which she supposed to be the pains of la- 
bour. The midwife, said, however, that she could not feel the child, but de- 
clared it to be dead, and took her leave, and did not return. The pains be- 
came urgent, a considerable haemorrhage ensued, but no waters were discharged. 
The motions of the child were now active and painful. The pains gradually 
subsided, but a stinking grumous blood continued to escape during the follow- 
ing three months. The breasts swelled, and secreted milk. The abdomen 
became flaccid, and the woman was at a loss what to think of her situation, but 
supposed that the child was dead and undelivered. She became emaciated. 
The left side of the abdomen above the hip was prominent and painful to the 
touch; she complained of numbness in the left inferior extremity, and an irregu- 
lar state of the bowels, which were affected with frequent diarrhoeas. In the 
summer of 1820, she passed, for the first time, by stool, after a severe pain, a 
bone not entirely deprived of the flesh, which she supposed to be one of the 
arm or leg. She afterwards passed the left half of the frontal bone, the two 
parietal, one entire, the other in three fragments, the occipital, the whole of 
the upper jaw, and half the lower, one malar, the sphenoid, temporal, and one 
clavicle, all firmly ossified, and apparently belonging to a full grown foetus. 
Dr. B. prescribed for her, during this period, opiates, involventia et roborantia, 
according to circumstances. She gradually improved, and by the end of April 
she had regained her health. In 1824, she enjoyed good health, and had had 
several returns of her menses. — Magazin der auslandisch en Literatur von Ger- 
son und Julius, Feb. 1830. 



MEDICAL JURISPRUDENCE. 

61. Poisoning by the Topical Application of Arsenic. — The danger of applying 
arsenic to large surfaces of the skin has long been known to medical men, the 
article is, however, frequently resorted to by irregular practitioners, and not 
unfrequently with fatal effects. In the Transactions Medicales, we find related 
the cases of three children who were destroyed by the use of this poison. These 
three children who were of the ages of seven, nine, and eleven, had scald 
head, to which the mother, at the recommendation of a charlatan, applied an 
ointment, which he assured her would cure her children in a few days. In a few 
hours the children were attacked with pains all over their body, dreadful colic, 
and the next day the youngest died, and the day after the two others. Dr. 
FmsTo, of Sierck, examined the bodies of these children, and the ointment 
which had been applied to their heads. The bodies were found swelled and 
ecchymosed; the membranes of the brain greatly injected; the substance of this 
organ inflamed, presenting a number of sanguinolent spots; lungs hepatized 
and engorged; stomach phlogosed; ecchymoses in the duodenum and small in- 
testines 

The ointment was found to contain arsenic. 

62. Poisoning with Coal Gas. — Repeated accidents have happened in Britain 
from the explosion of oil gas or coal gas; but, so far as we are aware, there has 
not yet been a single instance of poisoning or asphyxia produced by the incau- 
tious inhalation of it. There is every reason indeed to suppose that when in- 
haled in a moderately diluted state, it is a very feeble poison, and that when 
considerably diluted, it may be breathed habitually without danger and without 
inconvenience. An accident, however, has lately happened at Paris, which 
proves that there is a limit to the statement now made, and that the escape of 
a large quantity of gas into a house is attended with other risks — besides the 
chance of explosion from some fool walking into the contaminated apartment 
with a light to look for the cause of escape. In April last, five individuals in 

22* 



250 QUARTERLY PERISCOPE. 

a warehouse in the Rue de Bussy at Paris, were more or less severely affected, 
and one killed, in consequence of an accidental leak near the main stop-cock 
of the service-pipe. They went to bed about half-past ten, and about two, one 
of them who slept on the ground floor was awakened by the smell of the gas, 
and a sense of approaching stupor. He immediately alarmed his companions, 
who slept on various floors above, and found them all in a state of profound 
sleep, and when awoke excessively lethargic. Of the five individuals, four re- 
covered, and appear to have never been in great danger from the moment that 
they were freely bled from the arm. The fifth was heard moaning by the man 
who gave the alarm, and found insensible and incapable of being roused, with 
froth issuing from the mouth, vomiting, and spasmodic convulsions. A physi- 
cian was immediately procured, who found all the symptoms of great oppres- 
sion of the brain, complete coma, froth at the mouth, redness of the face, ster- 
torous respiration, and dilated pupils. An unsuccessful attempt was made to 
bleed him from the arm. Five-and-twenty leeches were then applied to each 
side of the neck; and as they filled, the wound in the vein of the arm began to 
bleed, while at the same time, the patient recovered his senses a little, and 
complained of being too soon awakened. His breathing, however, continued 
laborious, no further amendment took place, vomiting recurred between five 
and seven in the morning, and he died at eight, six hours after the alarm was 
given. 

When the body was examined next day, putrefaction had just commenced. 
The limbs, however, were extremely rigid. There was a good deal of pale li- 
vidity on different parts. The countenance was pale and not bloated, and the 
lips were not discoloured. The vessels of the dura mater discharged much 
blood when the skull-cap was removed; the vessels of the arachnoid were 
much gorged; and the substance of the brain presented an unusual number of 
red points when cut; but there was little serosity in the ventricles. The lungs 
were little distended, the left united to the pleura of the ribs by old adhesions, 
rather pale in colour anteriorly, and not at all gorged. The right lung, on the 
contrary, was violet-coloured, the edges of its lobules emphysematous, its sub- 
stance red, gorged with blood, and yielding much froth when squeezed. The 
membrane of the windpipe was in general white, and contained a good deal of 
froth. In the right bronchial tube there was a French bean of ordinary size; 
entire, boiled, and which had evidently proceeded from the stomach. There 
was no particular appearance in the heart and great vessels, except that the 
blood was every where completely and firmly coagulated. The surface of the 
intestines was reddish. The stomach contained fragments of French beans, 
which the deceased had taken for supper. The liver had entirely changed its 
appearance, and acquired a greenish-slate colour, and an unusually firm consis- 
tence. It appears probable from the dissection and symptoms antecedent to 
death, that the fatal issue of the case was rather owing to the obstruction of the 
right lung by the bean, than to poisoning with the gas. — Edinburgh Med. and 
Surg. Jour. Oct. 1830, from the Annates d' Hygiene Publique et de MSdecine-Lt- 
gale, Juillet, 1830. 






MEDICAL STATISTICS. 

63. Report of the Coombe Lying-in Hospital. By Richard Reed Gregory, 
Esq. — Since the opening of this institution on the 3d of February, 1829, 691 
patients have been delivered in the hospital, of whom nine died. The pre- 
sentations were as follows : — natural 645; face 2; breech 14; feet 7; arm 3; 
shoulder 1; funis 7; twin cases 12; total 691. 

"In two of the twin cases the breech presented, in two others the head; in 
one the first child presented with the head, the second with the feet; in another 
the first child with the breech, the second with the arm; the other six were pre- 
sentations of the head and breech. 



Medical Statistics. 



251 



"The following table exhibits the number of births, and the sex of the chil- 
dren, arranged according* to the age of the mother, from fifteen to forty-five in- 
clusive, taking" an average of every five vears. 



From 


3 


05 

S 


Total 

of 
Births. 


Still born. 


Total 
Still 
Born. 


Males. 


Females. 


15 to 20 


19 


15 


34 


2 


2 


4 


20 to 25 


114 


93 


207 


14 


6 


20 


25 to 30 


100 


88 


188 


9 


7 


16 


30 to 35 


106 


79 


185 


10 


2 


12 


35 to 40 


33 


23 


56 


1 


1 


2 


40 to 45 


15 


17 


32 





1 


1 


45 to 50 





1 


1 













387 


316 


703 


36 


19 


55 



" Of the still born children there were 29 premature, 2 abortions, 3 arm pre- 
sentations, 3 natural cases, 3 crotchet cases, 4 cases of prolapse of the funis, 3 
feet presentations, and 4 breech ditto: of the 12 cases of twins, four children 
were still born, making a total of 55 deaths. Premature labour is a circumstance 
of very frequent occurrence among the women residing in this district of the 
city, owing to their irregularity of living, and the brutal treatment they often 
receive from their husbands. 

"Of the arm cases, one did not come into hospital until twenty-four hours 
after the waters had drained off, and the child had been forced into the pelvis 
by the violent action of the uterus, which continued after her admission, so as 
to render turning impracticable. Spontaneous evolution, (as it is termed by 
Dr. Denman,) took place in this case in nine hours after her admission. The 
patient recovered without a bad symptom. 

"Another was admitted in the eighth month of pregnancy; she was seized 
with labour the day before, and the waters had been discharged for four hours 
previous to her admission. No difficulty, however, was experienced in turning, 
and the woman recovered rapidly." 

The third arm case was a second child in an instance of twins. 

" Of the crotchet cases. — The operation in one instance was had recourse to 
in consequence of deformed pelvis, and the length of time she had been in 
labour previous to her 1 admission, besides which there were unequivocal evi- 
dence of the child's death. The operation was performed with ease, and the 
child extracted with perfect safety to the mother, but very unfavourable symp- 
toms soon showed themselves, and ultimately sloughing of the neck of the 
uterus and adjoining parts took place, which caused her death fourteen days 
after delivery. 

" Another was a soldier's wife, who had been in labour four days previous to 
her being sent into hospital, during which time she said she had not passed 
water: the bladder was greatly distended. The operation of embryotomy was 
had recourse to immediately after her admission; the head being so impacted 
in the pelvis as to prevent the use of the forceps. When the child was extract- 
ing, it was found to be very much enlarged from putrefaction: she lived for 



252 QUARTERLY PERISCOPE. 

nearly three weeks, having laboured under a continued hoarseness, and nearly 
loss of voice. These symptoms existed at the time of her admission. On exa- 
mination after death there was ulceration of the chorda vocales, and evident in- 
flammation of the mucous membrane of the bronchial tubes. The uterus had 
two small abscesses in its substance. The third was operated on in consequence 
of the length of time, eighteen hours, the head had been in the cavity of the 
pelvis, without the slightest advance, though the labour-pains continued violent, 
and after the forceps had been tried. This woman speedily recovered 

" Of the funis presentations. — Two cases occurred in women who had come a 
considerable distance on foot, from the country, to be confined; a large portion 
of the cord was down, and pulsation had ceased previous to admission. 

"In the third case of funis presentation, the discharge of the waters, and 
the falling down of the funis were the first symptoms which attracted the pa- 
tient's notice, the former having fallen considerably below the external parts 
without any previous pain. 

" Of the footling cases, one was an acephalous foetus, and the cord presented 
along with the foot. Of the breech presentations, three were cases of prema- 
ture labour. 

"The following is a brief account of the remaining seven cases of death 
which occurred: — 

" Mary Nowlan died of rheumatic fever a fortnight after delivery. 

"Mary Cullen died of hemorrhage, occurring immediately after the expul- 
sion of the child. Her death was almost instantaneous. 

" Margaret Butler died in consequence of inflammation of the uterus and 
some of the adjacent parts. 

" Judith Riley was extremely delicate on coming into hospital. Inflamma- 
tion and sloughing of the upper and inner part of the uterus took place, which 
was not suspected during her lifetime; after death, on cutting into the diseased 
part, (which was not much greater in extent than the size of a crown piece,) 
it had much the characters of anthrax. 

" Mary M'Dermot died of consumption three days after delivery, which she 
had been labouring under for a long period previous to her admission. 

"Mary Maguire was admitted on the night of the 24th of July, 1830, and 
was delivered in two hours after. She was so ill from chest disease, apparently 
phthisis, that it was thought she could not survive the delivery. She died three 
hours afterwards; no examination was allowed. 

"Judith Foy was labouring under bronchitis on her admission, which rapidly 
increased after her delivery: she sunk in two days. 

" In one instance premature labour was induced, in consequence of contract- 
ed pelvis, in a woman named Mary Fox, of diminutive stature. About fourteen 
hours after the evacuation of the liquor amnii, she had a severe rigor, which 
lasted for an hour. In twelve hours after, slight labour pains occurred, these 
continued for about nine hours, when she was delivered. The child was born 
alive, but died in an hour. — Dublin Hospital Reports, Vol. V. 

64. Influence of certain occupations on the development of Phthisis Pulmonalis. 
— M. Benoistojj- de Chateaunettf, has communicated to the Royal Academy 
of Sciences of Paris, some very interesting statistical researches on this subject. 
From the report of M. Dumeril, made at the meeting of the sixteenth of De- 
cember last, we derive the following particulars: 

Those persons engaged in the construction of gun-flints, first engaged the 
attention of M. Benoiston. He had understood that the mortality among this 
class of workmen was very great, principally attributed to the frequent de- 
velopment of phthisis pulmonalis, or by the destruction of the lungs, by sup- 
puration. This branch of labour is carried on in the environs of St. Aignan, in 
the commune of Meusnes. M. B. has consulted the registers of this commune, 
and during a period of sixteen years, (from 1812 to 1828,) he has noticed 700 
births and 515 deaths. He afterwards obtained two necrological tables of the 



Medical Statistics. 253 

same village, for two periods of thirty years each; one before, and the other 
since the establishment of the manufacture of gun-flints. In the first, from 
1680 to 1709, the mean population was 415 souls; the births were then as 1 to 
24.08; the deaths as 1 to 33.24, so that the mean duration of life was nearly 
twenty-four years and three months. But from 1760 to 1790, a period at which 
the manufacture was in operation, the mean population was 1850 souls: the 
births were 1 in 22.78; and the deaths 1 in 29.60; so that the generation was 
reduced one-half before five years, instead of nineteen years and two months. 
This great mortality will naturally be attributed to the continual inspiration of 
the dust, which is produced in forming the gun-flints. 

M. Benoiston has pushed his researches further, and endeavoured to ascer- 
tain the influence of various occupations, which expose those engaged in it, 
either to an atmosphere charged with dust, or to laborious exertion or con- 
strained postures. 

These occupations, to the number of forty, are divided into seven classes: 
the males and females are considered separately. From the records of three 
of the hospitals of Paris, in which 43,010 patients were admitted within five 
consecutive years, from 1821 to 1826, Mr. B. has made out the following state- 
ment: 

1st. Professions which subject the lungs to the action of an atmosphere 
charged with vegetable particles. 

Males. Starch makers, died of pulmonary consumption, 1.02 per cent. 
Bakers, " " " 2.07 

Colliers, " " " 3.73 

Porters, " " " 2.43 

Eag pickers, " " " 0.84 

Workers in cotton, •■ " 1.88 

Winders, " " " 

Spinners, •• " " 2.35 

Mean mortality, " " " 2.07 

Females. Ragpickers, " " " 1.68 

Workers in cotton, «« «« 2.72 

Winders, " " " 3.42 

Spinners, " " " 1.61 

Mean mortality, " " " 2.19 

2d. Professions which subject the lungs to the action of mineral particles. 

Males. Quarriers, " " " 1.46 per cent. 

Masons and hodmen, " " 2.22 

Marble cutters, " " " 1.25 

Plasterers, " " " 2.53 

Stone cutters, " " '« 0.90 

Mean mortality, " " " 1.95 

3d. Professions which subject the lungs to the action of an atmosphere 
charged with animal molecules. 

Males. Brush-makers, " " 3.53 per cent. 

Wool-carders and mattrass-makers, " 3.10 

Hatters, » «« M 4.78 

Feather men, " " " 7.69 

Mean mortality, " " " 4.46 



254 QUARTERLY PERISCOPE. 

Females. Brush-makers, died of pulmonary consumption, 7.76 per cent. 

Wool-carders and mattrass makers, " 2.43 

Hatters, " " " 0.55 

Feather women, " " 11.47 

Mean mortality, " " " 3.39 



4th. Professions which expose the lungs to the action of an atmosphere 
charged with injurious vapours. 

Males. Gilders, " " " 5.32 per cent. 

Decorative painters, " " 2.17 

Chimney doctors, « " 3.34 

Mean mortality, " " « 2.87 

Females. Gilders, " " " 5.61 

5th. Professions which expose the body, and especially the lower extremi- 
ties, to the action of moisture. 

Males. Bleachers, " « " 1.83 per cent. 

Females. Ditto, " ** " 4.50 

6th. Professions which subject the muscles of the chest and superior extremi- 
ties to painful and continual exercise. 

Males. Weavers, " " " 2.13 per cent. 

Gauze-makers, " " 3.18 

Carpenters, " " " 1.49 

Joiners, " " " 3.08 

Blacksmiths and Farriers, " 0.93 

Locksmiths, " " « 0.74 

Water carriers, " " " 2.41 

Sawers of stone, " *< 1.12 

Mean mortality, " " " 2.12 

Females. Weavers, " " " 1.84 

Gauze-makers, «* " " 3.16 

Mean mortality, " " " 2.64 

7th. Professions which subject the muscles of the chest and of the arms to 
continual action, and the body to bent attitudes. 

Males. Writers, " " " 4.73 per cent. 

Jewellers, " " " 6.23 

Taylors, " " " 4.67 

Shoemakers, " " " 4.29 

Fringe and Lace makers, " •' 4.69 

Glass cutters, " " " 6.14 

Polishers, " " " 4.44 

Mean mortality, " « " 4.84 

Females. Jewellers, " " " 13.33 

Tayloresses, " " " 4.58 

Shoemakers, " « «« 5.54 

Fringe and Lace makers, " " 4.68 



Chemistry. 255 

Females. Polishers, died of pulmonary consumption* 3.83 per cent. 

Embroiderers, " " " 8.60 

Sempstresses, " *' " 5.48 

Florists, " " " 

Lace makers, " " " 6.20 

Glove makers, " " " 6.46 

Stocking- darners, '* " 6.11 

Mean mortality, " " " 5.66 

Mean mortality of the whole, 3.61 per cent.— Archives Generates and Mevue 
Me'dicale, Dec. 1830. 

65. Influence of certain Professions in the Production of Phthisis Pulmonalis. — - 
Dr. Lombard, of Geneva, has been engaged in some interesting- observations 
on this subject, and his results correspond remarkably with those of M.Benoiston 
de Chateauneuf. His documents are derived in part from the registers of the 
Parisian and other hospitals, and in part from the bills of mortality of the city 
of Geneva, in which bills the profession of the deceased and the causes of death 
are carefully registered. Dr. Lombard has observed, that the inhalation of 
vegetable are much less injurious than mineral powders. Thus, the frequency 
of death from phthisis being in Geneva, 0.20 in millers; it attains the enormous 
proportion of 0.67 in plasterers. He has also been struck with the deleterious 
influence of certain emanations which appears to him to be the cause of this 
disease in a great number of workmen of a certain description, such as hatters, 
varnishers of paintings, and enamellers, and he found the mortality from con- 
sumption was 0.42 at Vienna, and 0.31 at Geneva, among the hatters; 0.32 in 
varnishers; and 0.25 in enamellers. Concussions of the thorax appear to exer- 
cise little influence in the production of phthisis pulmonalis; he has found that 
occupations which require considerable movements of the arms are less exposed 
than others to contract this disease, and that in the ratio of 0.118 to 0.207 in 
Geneva, and in that of 0. 252 to 0.286 in Vienna. — Archives Generates, Jan. 1831 > 



CHEMISTRY. 

66. On the state of Mercury in Mercurial Ointment. By M. Mitocherlich.— 
The mercurial ointment employed, occupied four weeks in preparing; part 
of it was set to dissolve at a moderate temperature in alcohol containing caustic 
potash in solution. The mercury was separated in the metallic state, and 
formed one globule at the bottom of the vessel; the solution was filtered, and 
the metal was carefully removed from beneath the filter; a white matter re- 
mained, which was not removed by washing, and which heated in a tube gave 
no metallic mercury, nor did it sublime. 

From this experiment it appears that the ointment does not contain oxide, but 
metallic mercury. To be certain whether by the reaction of the alcohol and 
potash the oxide had not been reduced, the following experiment was made:— 
1 .101 gramme of protoxide of mercury was triturated for a long time with lard, 
The ointment thus prepared was subjected to alcohol, mixed with potash as in 
the preceding experiment. The portion remaining undissolved, had not the 
least appearance of metallic mercury, it weighed 1.196: submitted to distilla- 
tion with muriatic acid, no metallic mercury appeared, but 1.29 gramme of 
proto-chloride of mercury, equivalent to 1.089 of proto-oxide of mercury. A 
small portion of the sediment, when heated, did not sublime.— Philosophical 
Magazine, Jan. 1831, from Hensman's Repertoire, August, 1830. 

67. On the Existence of Hydrocyanic Acid in Cheese. — Dr. Witlikg has un- 
dertaken a series of experiments to ascertain the nature of the changes which 



256 QUARTERLY PERISCOPE. 

occur in some kinds of cheese; the results of his investigations are the follow- 
ing". — 1st. If cheese is well sweated, sufficiently salted, and dried at a mode- 
rate temperature, it never acquires poisonous properties. 2d. Its fermentation 
and alteration is in direct propertion to its moisture, especially when it is kept 
in a close place. 3d. When exposed to the action of water, and to the sun, in a 
few days it gives out an ammoniacal odour. In this state, if treated with alco- 
hol, this liquor yields on distillation some traces of hydrocyanic acid; it appears 
that this acid is united to the ammonia in cheese which has become changed. 
4th. At a more advanced, period of the fermentation, no trace of this acid is to 
be found. It therefore appears the deleterious property of some kinds of 
cheese is owing to the formation in them of hydrocyanic acid. — Journal de 
Chimie Medicate, Bee. 1830. 

68. Analysis of the Pulmonary Exhalation. — We have already noticed Vol. 
VI. p. 485, M. Collabd de Maktignt's researches on pulmonary exhalation, 
and absorption; the following is his analysis of the vapour given out by the 
lungs, and which has been made since the publication of the memoir formerly 
noticed. Water, 0.907; carbonic acid, 0.090; animal matter, 0.003. No ammonia 
was found. This analysis has been repeated upwards of twenty times, and 
with vapour from the lungs of persons of different ages with the same results. 
—Ibid. 

69. Preparation of Salicine. — This article appears to be acquiring some re- 
putation in Europe as a substitute for quinine; the following is the process for 
preparing it, recommended by M. Peschier. The bark of the willow is to 
be dried, crushed, boiled for one or two hours in water, and the liquid sepa- 
rated by a cloth and powerful pressure. Sub-acetate of lead is to be added as 
long as precipitation occurs; the whole filtered; the clear liquor boiled with 
enough carbonate of lime to decompose the' excess of acetate of lead, saturate 
the acetic acid, and remove the colour. Being left to settle, the clear liquor 
is to be decanted, the deposit washed twice or thrice, the washing liquor added 
to the former, and the whole evaporated to the consistence of an extract. This 
extract, whilst hot, is to be put on bibulous paper, and pressed for some hours: 
after which it is to be digested in alcohol, of s. g. 0.847, the fluid filtered and 
concentrated, when it will yield crystallized salicine, very white and pure. 

Salicine thus obtained, when administered in doses of from fifteen to eighteen 
grains, during the apyrexia of intermittent fevers, is said to have been found 
effectual in arresting their progress. — Ann. de Chimie. Vol. XLIV. 

70. Presence of Manganese in the Blood. — In some analyses of human blood, 
according to Engelhart's method, by liquid tests, Professor Wttrzer, of Mar- 
burg, was led to suspect that, besides the usual results, he had also obtained a 
small quantity of manganese, not being, however, quite sure of the correctness 
of his analyses, he was induced to repeat them in the following manner: — The 
blood, which had been obtained by venesection, on the day before the experi- 
ment, was ignited in an open crucible, the incinerated mass oxydized by nitre, 
and then diluted with water; the residuum was dissolved in muriatic acid, and 
the iron precipitated from the solution by succinate of ammonia. As the pre- 
cipitate contained also some phosphate of lime, it was again ignited, and then 
dissolved in muriatic acid; the phosphate of lime was separated from the solu- 
tion by alcohol, the excess of the latter expelled by heat, and the iron precipi- 
tated by ammonia. By boiling the filtered liquid with carbonate of soda, the 
manganese was precipitated, and then dissolved in nitric acid, and again ignited. 
In two grammes of the coal was found 0.108 ox. of iron, and 0.034 protox. 
of manganese. — Journ. of the Royal Institution of Great Britain, Feb. 1831, from 
Poggendorff's Ann. der Physik und Chemie. 



Miscellaneous. 257 



MISCELLANEOUS. 

71. Case in which several Leeches were Sivallowed.—Dv. Schntjhr reports the 
case of an individual who, while in the act of bathing-, accidentally swallowed 
several leeches. The immediate consequences were intense burning" of the 
stomach, loss of appetite, sickness at stomach, and frequent discharges of blood 
by vomiting, with which one of the animals was ejected on the third day. Pale 
and emaciated, he applied for relief on the eighth day. The physician directed 
him to take a saturated solution of muriate of soda, to be followed in three-quarters 
of an hour by a dose of ol. ricini. This had the effect of bringing away three 
leeches, after which the vomiting of blood and pain of the stomach subsided. — 
Huf eland and Osann's Journ. fiir Pract. Heilkunde, B. 70, Stuck. 2. 

72. Acoustic Chair. — Mr. Curtis, of London, Surgeon to the Royal Infirmary 
for Diseases of the Ear, has invented an acoustic chair for the benefit of per- 
sons afflicted with deafness. The chair is of the library form, with high back 
and sides, and the chief parts of the acoustic apparatus are concealed in the 
stuffing — all that is visible being a mouth piece on the outside near the top, 
and a small tube on the inside for applying to the ear. Mr. C. intends taking 
out a patent for his invention, and the mode of construction of his chair is, 
therefore, as yet not made known; as soon as it shall be so, we will present an 
account of it to our readers. 

73. Connexion of Diseases with the Rock Formations of a Country. — Amongst 
a great many of the communes of Calvados, in France, near to each other, and 
exposed to the same climatic influences, there is one which is particularly liable 
to fever. Nearly the whole of these communes are situated upon lias and red 
marl, and some other clayey formations, which retain at the surface a humidity 
favourable for the formation of fogs. On the contrary, the communes situated 
on rocks having a loose texture, and which permit the rain water to escape 
more easily, such as the great oolite, chalk, &c. or which do not present any 
beds capable of arresting the course of the water, as granite and certain slates, 
appear less liable to fevers. It results from these general considerations, that 
the soil, by its greater or less hygroscopic quality, may have an effect on the 
state of health, by favouring more or less the development of certain diseases. 
M. de Caumont does not regard this observation as new, but communicates it 
with the view of ascertaining in what proportions, (every thing being. equal,) 
the fevers and other maladies are developed in the principal geological regions 
of Calvados; for example, in that of granite, slate, limestone, clay, &c. — Lon- 
don Med. and Phys. Journ. Jan. 1831, from the Journal de Geologie. 



No. XV.— May, 1831. 23 



( 258 ) 



AMERICAN INTELLIGENCE, 



70 and 80 


« 


a 


70 


tt 


144 under 242. 


60 and 70 


tt 


tt 


60 


<( 


212 


" 174. 


50 and 60 


tt 


tt 


50 


ft 


250 


" 136. 


40 and 50 


a 


<( 


40 


(C 


268 


« 118. 


30 and 40 


tt 


(i 


30 


it 


282 


" 104. 


20 and 30 


it 


a 


20 


(( 


301 


" 85. 


10 and 20 


tt 


tt 


10 


tt 


310 


" 76. 


and 10 















Medical Statistics of the Moravian Society, established at Bethlehem, Penn. — 
"We are indebted for the following highly interesting statement, derived from 
the church records of the Moravian society, established at Bethlehem, Penn. 
to our learned and valued friend, Lewis D. de Schweinitz. 

From the first of January, 1801, to the first of January, 1831, a period of 
thirty years, 386 deaths have occurred in this congregation, forming a popula- 
tion which increased during the period from 501 persons, to 722 persons. 

Of the above-mentioned 386 persons, none obtained the age of 100 years: — 
6 died aged above 90 years. 
55 died aged between 80 and 90 years, above 80 years of age 61. 
83 " " 

68 

38 " " 

18 " " 

14 " 

19 

9 '* " 

76 

It appears, therefore, that the decenium of human life in which the greatest 
number of deaths occurred was between 70 and 80 years, viz. 83 deaths out 
of 386, while the deaths under 10 years were only 76 out of 386. A con- 
siderable majority of deaths were of persons above 60 years of age, and 
more than double as many over 40 than under. 

In the same period 350 births took place. 

Of the inhabitants of Bethlehem alive on the 1st of January, 1831, there were 
14 above 80 years, 48 above 70 years of age, 226 under 12 years. 

In the above statement of the population, the boarding school for young 
ladies is not included. This has been established since the year 1785, and 
between 1900 and 2000 scholars have lived in it successively during this 
period of 46 years. 12 deaths have taken place among this number, which are 
not included in the above statement. 

Treatment of Dyspepsia. By J. E. Cooke, M. D. — In the review of the Pa- 
thology and Therapeutics of Dr. Cooke, which will be found in another de- 
partment of this number, the extent to which the author of that work ad- 
ministers purgatives in the treatment of dyspepsia, is spoken of, but the quan- 
tity said to be taken in some cases, is so extraordinary and unparalleled 
in the records of medicine, that it would be impossible for the reader to form 
any notion of the practice, without an example: we therefore extract two 
cases from the second volume of the work, and that the author may be fairly 
represented, we shall quote them at full in his own words. 

" Case I. A lady of thirty or thirty -five, delicate form, pale complexion, had 
had for some years all the symptoms of dyspepsia, in a high degree; had a 
great deal of acid in the stomach, and severe pains in it and the neighbouring 
parts; frequently vomited, sometimes a viscid acid fluid, and sometimes a limpid 
tasteless fluid, and was very much troubled with wind in the stomach; had 
been compelled to restrict herself to a few articles of diet, and with all her 
care suffered excessively. She had, in addition to these symptoms, pain in the 
head, right side, between the shoulders, through the chest, and in the kidneys. 






American Intelligence. 259 

She had palpitation, a pulsation at the top of the sternum sometimes, and one 
in the abdomen frequently. She had also slight convulsive motions in the 
muscles of the hand and fore-arm. Her pulse was very weak and slow. 

"She had, on the day I was first called, taken an emetic, which had operated 
smartly, and she had thrown up a small quantity of blood of a black colour; on 
which account she had desired my assistance. She was advised to make an ef- 
fort to obtain relief from the whole of the symptoms, and not to be satisfied 
with temporizing-; to which no objection being- made that need be mentioned, 
she immediately commenced by taking- a mercurial cathartic, and on the next 
day another. 

" Nov. 28. Finding the medicine had not operated well, she took of scam- 
mony thirty grains, and calomel ten. Nov. 29. Took scammony forty grains, 
aloes twenty, in pills; and as the operation was slow, it was aided by calcined 
magnesia. Nov. 30. Took scammony twenty grains, aloes five grains, calomel 
ten grains, in four pills: magnesia calcined, half an ounce. Little or no opera- 
tion yet. 

"Dec. 1. Took scammony, aloes, and calomel, six pills. The aloes was 
employed, because to rhubarb she had an utter aversion. Dec. 2. Took cal- 
cined magnesia and senna; not weighed but marked large doses. She took 
three or four times as much as common to operate; as one ounce of senna, or 
half an ounce of magnesia. Dec. 3. Took scammony sixty grains, jalap thirty 
grains, in twelve pills: magnesia a large dose. Dec. 4. Took scammony se- 
venty grains, in pills: magnesia a large dose. For the last four days the pas- 
sages, (there were several every day,) consisted entirely of black blood. On 
one day the chamber pot was half full. The friends were all much alarmed at 
first; but being assured that I had never experienced any other than a salutary 
effect from such discharges, and finding that she actually was considerably re- 
lieved, they were satisfied. 

" Dec. 5. She took of scammony twenty grains: of magnesia a large dose. 
The discharges to-day, a medium between black blood and black-green bile. 
Dec. 6. Took scammony and calomel, twenty and ten: a large dose of magne- 
sia. The discharges, a pure black-green bile, colouring the sides of the pot, 
as it was moved from side to side, of a yellow colour. Dec. 7. Took scammo- 
ny and calomel, twenty and ten: magnesia. 8th. Took nothing. 9th. Mag- 
nesia alone. During these three days the discharges changed to a yellow, and 
she was able to go about, greatly relieved in every particular, indeed consider- 
ing herself so well as to neglect my urgent request, that she would for some 
time, take medicine sufficient to procure at least two passages a day. 

" Dec. 14. However, in consequence of this neglect, she had a return of the 
symptoms with great violence. She had an excessive quantity of acid in the 
stomach; violent vomiting, the struggle being actually alarming; pains in the 
stomach and bowels, the sternum, the shoulders, or towards the shoulders and 
back, the liver, and kidneys, Took in the night six pills of scammony, rhu- 
barb, and calomel. 

" Dec. 15. Six pills of jalap, aloes, and calomel. 17th. Four pills of the 
same. 18th. Scammony, twenty grains. 19th. Jalap and aloes, four pills. 
These medicines operated pretty well, and she improved daily in every 
respect. 

** From December 19th to the 29th she took medicine occasionally only; in 
all, of aloes, eighty grains; of jalap, twenty; and one dose of senna. The acid 
gaining head, she took on the 30th, magnesia with a little soda, and twelve 
grains of aloes. Dec. 31. Senna and magnesia. 

"Jan. 1. Magnesia. 2d. Senna and magnesia. The discharges from these 
medicines were all light coloured and thin, and she was getting worse; so as 
again to request my attendance. 

"Jan. 3. Scammony, twenty grains. 4th. Scammony and calomel, two 
doses. 5th. Senna and magnesia. 6th. Scammony and calomel, ten grains of 
each, and some magnesia. 7th. Scammony and calomel, of each twenty grains. 



260 QUARTERLY PERISCOPE. 

and some magnesia. The magnesia in almost every instance, was of her own 
prescribing; which she, through desire of present relief, took in place of re- 
peating the scammony, when the first dose did not operate. The discharges 
were still light coloured and thin, and she was rapidly getting worse. This 
consequence was urged upon her; and she was at length convinced, to use her 
own words, ' that nothing but thorough work would do,' and was determined 
to give up the magnesia. 

"Jan. 8. She was by this time very low. She took eight pills of jalap, 
aloes, and calomel, with two of scammony and calomel, which I had about me, 
to make out a dose. 

" Jan. 9. Sundry cathartic pills with calomel at several times in the day. 
10th. Twelve pills of rhubarb, aloes, and calomel. 11th. Sixteen pills of ja- 
lap, aloes and calomel. For the first two days, she was in excessive pain in the 
stomach, &c. the medicine not operating until to-day; but she resolutely with- 
stood the inclination to take magnesia. This day, the discharges became black 
and free, and she felt decided relief. During the time that elapsed from the 
8th, until the medicine operated, she suffered most severe, most excruciating 
pains. There were moments when her sufferings were awful. Several friends 
were continually engaged about her in restraining her from injuring herself, by 
her tossing about, and occasionally in holding her up in bed. On one occa- 
sion, while thus supported, she fainted in their hands with excess of pain; and 
such was the intense and almost intolerable anxiety and agitation, that her 
death would undoubtedly have been a relief to their feelings. During this 
period, staying much with her for the sake of observation as well as attention, 
I observed that when the pain was most excruciating, the pulse was very low; 
and that when she was easy the pulse was full. It was immediately determin- 
ed to support the pulse with hot brandy toddy, until the mercurial cathartics, 
now freely used, should act not only on the bowels but on the pulse, as they 
generally do in a few days. The relief was instant on the first trial of the brandy. 
In a few minutes she was lying quite easy, when it was a matter of surprize to 
find, although it was expected, and the treatment was planned on the expecta- 
tion, that the pulse was full and soft. The only dread I had entertained, was 
that she would die before the medicine could have time to act. I now thought 
her in my reach, though all around considered her death inevitable. She took 
after this time, hot toddy whenever in pain, and relief was obtained generally 
in a few minutes. After the medicine had operated as above stated, (11th) 
producing free black passages, the pulse became more uniform, the necessity 
for the brandy ceased, and it made her sick to take it. 

'" During several days following the 11th, she took large doses of mercurial 
cathartics, which operated freely: the passages, at first black, became next 
deep green, and finally yellow; and she mended every day. During this ope- 
ration, she for several days felt severe pain, which the attendants frequently 
mistook for the original pains; but it was evident to me that they were caused 
by the griping of the medicine, and the acrid nauseating bile discharged. ^ She 
herself clearly distinguished between them. The original was excruciating, 
and seated in the different parts above mentioned; the latter was in the bowels 
alone; and from the attendant motions of the bowels, from the nausea, and its 
being shortly followed, when severe, by a passage, could not be from any other 
cause than the one assigned. During these days she took very large doses of 
medicine; this was necessary; it was fully ascertained by many trials, that nothing 
short of what was given would effect the purpose. She took on the 12th, in 
pills, seventy grains of scammony, and forty of calomel. On the 13th, scam- 
mony, sixty-four grains; calomel, thirty-two grains; rhubarb, ten grains. 

" Jan. 14. Sixteen pills of the same. 15th. Twelve pills of the same, except 
the calomel. 16th. Scammony and calomel, forty and twenty, with some 
senna. 17th. Scammony and calomel, of each twenty grains; scammony and 
rhubarb, sixteen pills. Pills, when the weight is not stated, contain almost 
universally five grains each. During this time she improved every day; was 



, American Intelligence. 261 

not troubled with acid after the 12th; and vomited only now and then on taking 
the jalap pills. 

" Jan. 18. Ptyalism appearing", and wishing- to substitute some other exci- 
tant for the calomel, directed her to take columbo, which she did for somedays, 
together with the cathartics, but did not take much. 19th. She took jalap, 
aloes, and calomel, twenty-four grains of each. 20th. Jalap and aloes, of each 
thirty grains. 21st. Jalap, fifteen grains. 22d. Jalap, thirty grains. 23d. 
Jalap, fifteen grains. Some return of pain in the course of the day; took eight 
pills of jalap, aloes, and calomel. 24th. Twelve of the same. 25th. Jalap 
sixty grains. 26th. Considerable pain this morning. On enquiry found the 
attendants had given the pills faster than directed; in consequence of which, 
instead of a few loose consistent yellow passages, she had a number of thin and 
watery ones; after which the pain came on. Something of the same kind occurred, 
it will be seen on looking back, on the 23d, after taking for three mornings ja- 
lap, without aloes or calomel: and the same occurred to a much greater ex- 
tent after taking magnesia and senna for some time in the commencement. 
In consequence of the return of pain, though the mouth was sore, she took 
calomel with her pills. 

" Jan. 27. Apprehending that the mouth would become very sore, determined 
to use the nitrate of silver, which I had often used with jalap and aloes, instead 
of calomel, and had found to act very much like it, not only in affecting the 
appearance of the discharges, but in raising the pulse; one grain of the former, 
however, being equal to ten of the latter in effect. During this and the three 
following days, she took, each day, four pills at intervals in the morning, when 
the pulse was lowest; each pill contained of jalap, two grains; and of the ni- 
trate of silver half a grain. The medicine did not act sufficiently, and raised 
the pulse very much, producing head-ache. 

"Jan. 31. Took scammony and aloes, of each ten grains, and of the nitrate of 
silver half a grain, in four pills at once. 

" Feb. 1. The mouth having become less sore, took eight pills of jalap, 
aloes, and calomel, 2d. Six pills. 4th. Five pills of scammony, aloes, rhu- 
barb, and calomel. 6th. Three pills of the same. The discharges became na- 
tural in consistence about the 21st of January. The appetite has been for some 
time very good; no acid, (see Jan. 17;) no vomiting; no pain; no water brash; 
strength returning; colour good and healthy. Continued to take pills of rhu- 
barb and aloes occasionally, after my attendance ceased. March 17th. She has 
taken her pills only occasionally since last date; but often enough to procure 
a habitual discharge twice a-day from the bowels. She continues well; her 
colour usually pale, is now quite good; eats those things which she could not 
formerly indulge in; indeed eats any thing, apples being mentioned as the only 
thing which produced any uneasiness in the stomach; uses coffee, which until 
lately, she dare not touch. 

" August. Has had this summer a continued discharge from the bowels of a 
bilious appearance. Her colour is still quite good, and she is more fleshy than 
she has been for many years.'* 

Case II. A man residing near a mill-pond, had an ague and fever in 1807: 
after getting rid of the fever he continued pale, his liver and spleen were 
swelled, and he had a cough. The patient was subsequently attacked with the 
ordinary symptoms of dyspepsia; and the author gives a very brief detail of the 
progress of the disease, from the attack up to the summer of 1825; which, as 
it does not bear immediately upon the treatment subsequently pursued, we 
shall omit. We have indeed to regret that this account is so brief, and that no 
information is furnished as to the treatment adopted for the cure of the fever, 
so as to enable us to form a positive opinion as to any influence the reme- 
dies employed for the cure of the fever, may have had in laying the foundation 
of the subsequent disease. If, however, the purgative plan recommended by 
our author, was employed, there would be much ground to suspect that the 
disease was induced by the use of the remedies; as one of the most common 

23* 



262 QUARTERLY PERISCOPE. 

cases for which we are here consulted, by patients from the south and west, are 
the various forms of chronic irritation and disorganization of the abdominal or- 
gans, induced by the remedies employed for the cure of the fevers of those 
sections of our country. 

In April, 1825, this patient came to Winchester. " At that time he had a 
small passage every morning, pale yellow bordering on clay colour, rather firm 
to pass easily; stomach flatulent; no acid for near a week, but could not take 
any nourishment but milk and water with a little loaf sugar, and a cracker; no 
meat but lean bacon. This was his meal, morning, noon, and night. He could 
not even drink water in the interval of meals, as it disordered his stomach." 

For ten weeks, pills of rhubarb, aloes, and calomel, rhubarb and calomel, and 
aloes and calomel, according to circumstances, were constantly given, during 
which time the patient "took about half an ounce of calomel," with apparent 
benefit. 

About the last of July, Winchester became sickly, and the patient is said 
soon to have felt its effects: "his complexion became very dark; stomach dis- 
ordered; not able to drink water, though troubled excessively with an internal 
burning and violent thirst; his passages became almost as thin as water; and he 
was so weak that he was confined to his room, lying on the bed chiefly. 

" July 27. Took ten grains of calomel alone. 28th. Ten grains of calomel, 
not being quite active enough, took on the 29th, ten grains of calomel, with 
five of rhubarb : the three following days, twenty grains of calomel, with ten 
of rhubarb each day: the bowels not being sufficiently moved by these doses, 
they were gradually increased, so that on the second of August he took ten 
grains of rhubarb, and thirty of calomel; 3d, of rhubarb fifteen grains, and 
thirty of calomel; 4th and 5th, of rhubarb and calomel, of each thirty grains, 
on both days; 6th and 7th, forty grains of each on both days; 8th, of rhubarb 
fifty grains, and forty of calomel; 9th, of jalap and rhubarb, of each twenty 
grains, with forty of calomel; 10th, the jalap producing nausea, he took of 
scammony twenty grains, rhubarb twenty, calomel forty grains. The passages 
from all these medicines were dark green, thick and consistent, about two a 
day. He complained most of weakness when there was no passage; and after 
the second operation of the last dose, felt greatly benefited in his feelings. His 
pulse was always fuller when there was an operation. The large doses pro- 
duced no more passages than the small, but the passages were larger; except 
that the discharges were freer from the jalap and scammony on the 9th and 
10th, being larger and more numerous, on which occasion he experienced the 
decided benefit above stated. It is to be observed, that the necessity for large 
doses was not confined to him; but that in this season it was a general obser- 
vation among physicians, that uncommonly large doses were requisite to pro- 
duce the usual effect on the bowels. 

" Aug. 11. Took this day of scammony and rhubarb, of each twenty grains, 
with twenty of calomel, which operated well; passages green; appears better 
and thinks himself so; has had for two or three days a great desire for pickles; 
thinks much of eating, though he has taken nothing for many days but milk and 
water, with a little sugar. Took in the course of the day, one-third of a drachm 
of muriatic acid in a quart of water. 12th. Slept well; drank this morning a 
considerable draught of boiled milk, which he relished. Took jalap and aloes, 
twelve pills; puked him violently, operated indifferently; two-thirds of a 
drachm of the same acid in the course of the day; feels very weak. 13th, 14th, 
and 15th. Took of scammony and rhubarb, each forty grains, with thirty of 
calomel, on each day. 

"Aug. 16th to 19th. Took rhubarb eighty grains, calomel forty every day; 
20th to 22d, rhubarb ninety grains every day. All these medicines operated in 
the desired manner, excepting that the passages were small. There were 
from three to five passages a-day, of nearly black, viscid thick matter. 

"23d. The operation being small, tried jalap again. He took jalap sixty 
grains and calomel thirty. All these medicines, except the senna and magne- 






American Intelligence. 263 

sia, were given in the shape of pills; and he in most instances, took the whole 
in a few minutes as one dose. The last pills were immediately thrown up; 
soon after gave him calcined magnesia, as there seemed to be a necessity for 
something to act more freely than the rhubarb and calomel did, both on ac- 
count of the black matter which ought to be evacuated, and the fear of ptyal- 
ism. 24th. Scammony and calomel, of each thirty grains, magnesia calcined, 
eighty grains; through the day the discharges were black and thick; while 
this black matter was passing, there was great nausea. 25th. Magnesia alone, 
twenty heaped tea-spoonfuls in the course of the day, in four doses; several 
large black and more fluid discharges, very offensive. 26th. Took scammony 
thirty-two grains, and calomel sixteen; also eight heaped tea-spoonfuls of mag- 
nesia in two doses; passages thick, tenacious, not so dark. 27th. Took scam- 
mony sixty grains, calomel thirty; magnesia repeatedly; one yellow passage, 
thick and tenacious. 28th. Scammony eighty grains, calomel forty; magnesia 
twenty-four tea-spoonfuls heaped; yellowish thick passages. 29th. Scammony 
eighty grains, calomel forty; no magnesia; no operation. 30th. Early this 
morning, two darker, thick, tenacious passages. In the evening, took scam- 
mony fifty-four grains, calomel twenty-seven. The same dose was prescribed 
as for yesterday; but he only took eight of the twelve large pills into which 
the scammony and calomel was made. 

"31st. He took scammony twenty-seven grains, and calomel thirteen, and 
sixteen tea-spoonfuls of magnesia: to-day he had two yellow, thick, tenacious 
passages. This change to yellow being evidently the consequence of the ad- 
ministration of magnesia, I determined to omit it, though he had taken much 
calomel, and run the risk of ptyalism: without this medicine the discharges 
were not dark, and when they ceased to be of that colour, his countenance im- 
mediately blackened, and he felt weaker and oppressed; so that he begged for 
something to bring off the black matter, which he was always glad to see. At 
this time he was very thin; and though he ate very little, he had for some time 
indulged in things which a few weeks before he could not have touched; viz. 
toast buttered, and soft bread and tea. 

" Sept. 1. Took early in the morning scammony two drachms, and calomel 
one drachm; the magnesia being omitted, the scammony was necessarily in- 
creased: he had three or four moderate passages, reddish or deep orange co- 
loured, tenacious, and thick. 

** Sept. 2 to 6. Scammony one drachm, calomel half a drachm, every day; 
dark passages every day. 7th. Jalap, aloes, and calomel, each one drachm. 
The nausea having disappeared, jalap was substituted for the scammony. Ap- 
prehensive of ptyalism from the quantity of calomel he had taken, he took 
magnesia, twelve tea-spoonfuls at two doses, in the course of the day. Pas- 
sages still dark; appetite less and less, till he ate nothing, and drank nothing 
the whole day. 

" 8th. Jalap and aloes, of each one drachm, calomel half a drachm; passages 
not so dark. 9th. Jalap and aloes, of each one drachm; magnesia two doses; 
passages lighter. 10th and 11th. The same medicines, with the same effect. 
For some days two or three passages in twenty-four hours. 12th. Jalap and 
aloes, of each eighty grains, with magnesia; four or five large, thick, reddish 
passages, the last one yellow. 

" 13th. He had taken his medicine late yesterday, and was kept awake all 
night. This morning felt weak, pulse very weak; complained that his heart 
was painfully oppressed. Gave him hot French brandy toddy till his pulse 
filled; his colour returned; his pains were gone; he wanted to eat, and chose 
thickened milk, which agreed well with him. 14th. Jalap and aloes, of each 
forty grains; no magnesia. 15th. About day-light a small yellow passage, per- 
fectly natural; appetite increasing; no medicine. 

" 16th. One passage about three o'clock, (afternoon,) large, soft, and per- 
fectly natural in colour. Eats heartily of thickened milk, a pint at a meal, 
three meals a day: tried beef soup, it made him feel sick, but produced no 



264 QUARTERLY PERISCOPE. 

other inconvenience; no medicine. 17th. From this time till the end of the 
month, took pills occasionally; in all, of jalap one hundred and fifty grains; of 
rhubarb one hundred and ten grains; of aloes two hundred grains, and calomel 
forty grains. 

"The discharges were in general natural, sometimes somewhat dark; but 
the appetite, contrary to all my experience, declined; so that instead of taking, 
as on the 16th, &c. a pint of thickened milk at a meal, three times a day, he 
was satisfied with half a saucer-full twice a day." 

The case being of long standing, Dr. C. " began to think the stomach had 
become so disordered, that although the cause, accumulation of blood in the 
venous cavity, seemed by the passages to be removed, the proper secretion 
would not go on;" and he therefore determined to try the bark, which, how- 
ever, produced no benefit. It being ascertained that since the recovery of his 
appetite, the patient indulged in toddy five or six times a day, he was ordered 
to give it up; after which his appetite improved. In November he again took 
improper diet, and his appetite rapidly declined. In the course of a fortnight 
"his appetite was prostrated:" "the discharges from the bowels increased in 
number, and became thin and abundant;" and about the first of December he 
died. "His relapse and death," says Dr. C. "were clearly caused by improper 
diet, and the use of brandy." 

It must be remarked, that it is acknowledged by Dr. Cooke, that these ex- 
traordinary doses have not been necessary, except in the cases which he cites, 
and two of which we have copied. 

The Study of Anatomy Legalized by the Legislature of Massachusetts. — We 
have been favoured by one of our colleagues in Boston with the able "Report 
of the Select Committee of the House of Representatives, on so much of the 
Governor's Speech at the June session of 1830, as relates to Legalizing the 
Study of Anatomy;" and we congratulate our friends in Massachusetts on the 
passage of the following bill, which is nearly the same as that reported by the 
committee, entitled "An Act more effectually to protect the Sepulchres of the 
Dead, and to legalize the Study of Anatomy in certain cases. 

" Sect. 1. Be it enacted by the Senate and House of Representatives, in General 
Court assembled, and by the authority of the same, That if any person not being 
authorized by the board of health, overseers of the poor, or select men in any 
town of this Commonwealth, or by the directors of the house of industry, 
overseers of the poor, or mayor and aldermen of the city of Boston, in said 
Commonwealth shall knowingly or wilfully dig up, remove, or convey away, 
or aid and assist in digging up, removing or conveying away, any human body, 
or the remains thereof— such person or persons so offending, on conviction of 
such offence in the Supreme Judicial Court of this Commonwealth, shall be ad- 
judged guilty of felony, and shall be punished by solitary imprisonment for a 
term not exceeding ten days, and by confinement afterwards to hard labour 
for a term not exceeding one year; or shall be punished by a fine not exceeding 
two thousand dollars to enure to the benefit of the Commonwealth, and by 
imprisonment in the common jail for a term not exceeding two years at the 
discretion of the court, according to the nature and aggravation of the 
offence. 

" Sect. 2. Be it further enacted, That if any person shall be in any way, either 
before or after the fact, accessary to the commission, by any person or persons, 
of the offence described in the first section of this act, such person or persons 
shall be adjudged and taken to be principals, and shall be, on conviction in 
the court aforesaid, subject to the same punishments and forfeitures as are in 
said first section provided. 

" Sect. 3. Be it further enacted, That from and after the passing of this act, 
it shall be lawful for the board of health, overseers of the poor, and selectmen, 
of any town in this Commonwealth, and for the directors of the house of in* 
dustry, overseers of the poor, and mayor and aldermen of the city of Boston, 



American Intelligence. 265 

in said Commonwealth, to surrender the dead bodies of such persons, except 
town paupers, as may be required to be buried at the public expense, to any- 
regular physician, duly licensed according to the laws of this Commonwealth — 
to be by said physician used for the advancement of anatomical science; pre- 
ference being always given to the medical schools that now are or hereafter 
may be by law established in this Commonwealth, during such portions of the 
year as such schools, or either of them, may require subjects for the instruction 
of Medical Students: — Provided always, That no such dead body shall in any 
case be so surrendered, if, within thirty-six hours from the time of its death, 
any one or more persons, claiming to be kin, friend, or acquaintance to the 
deceased, shall require to have said body inhumed; or, if it be made to appear 
to the selectmen or overseers of the poor of any town in this Commonwealth, 
or to the mayor and aldermen or overseers of the poor of the city of Boston, 
that such dead body is the remains of a stranger or traveller, who suddenly died 
before making known who or whence he was: but said dead body shall be in- 
humed, and, when so inhumed, any person disinterring the same for purposes 
of dissection, or being accessary, as is described in the second section of this 
act, to such exhumation, shall be liable to the punishments and forfeitures in 
this act respectively provided: — And provided further, that every physician so 
receiving any such dead body, before it be lawful to deliver him the same, 
shall in each case give to the mayor and aldermen of the city of Boston, or to 
the selectmen of any town of this Commonwealth, as each case may require, 
good and sufficient bond or bonds, that each body by him so received, shall be 
used only for the promotion of anatomical science; that it shall be used for 
such purposes only in this Commonwealth, and so as in no event to outrage the 
public feeling; and that, after having been so used, the remains thereof shall 
be decently inhumed. 

" Sect. 4. Be it further enacted, That from and after the passing of this act, it 
shall be lawful for any physician duly licensed according to the laws of this 
Commonwealth, or for any medical student under the authority of any such 
physician, to have in his possession, to use and employ, human bodies, or the 
parts thereof, for purposes of anatomical inquiry or instruction. 

" Sect. 5. Be it further enacted, That nothing in this act shall be so construed,, 
as to give to the board of health, overseers of the poor, or selectmen, of any town 
in this Commonwealth, or to the directors of the house of industry, overseers 
of the poor, or mayor and aldermen, of the city of Boston, in said Common- 
wealth, any power to license the digging up of any dead human body, or the 
remains thereof, other than was possessed by them before the passing of this 
act, or is given them by the third section of this act. 

" Sect. 6. Be it further enacted, That the act passed March 2, 1815, entitled 
* An Act to protect the Sepulchres of the Dead,' and also all other Acts, or 
parts of acts, contravening the provisions of this act, be and the same hereby 
are repealed. 

il Approved by the Governor, February 28^." 

Constitution of the General Medical Society of Ohio. — On the 26th of Febru- 
ary, 1824, the legislature of Ohio passed "An Act to incorporate Medical So- 
cieties, for the purpose of regulating the practice of Physic and Surgery in this 
State." By the 1st section of this act, the state is divided into twenty districts, 
which by an amendment in 1827, is increased to twenty-two. The 2d section 
designates the persons who shall constitute the first society. The 3d section 
indicates the period and place at which the first meeting of the society shall be 
held. The 4th section points out the method of organizing the society. The 
5th section provides for the election of censors and points out their duties. The 
6th section fixes the last Tuesday in May as the period of the annual meeting. 
The 7th section requires that every physician and surgeon resident in the state 
previous to the first meeting of the society, having a license or diploma from 
any regularly organized society or college, who has attended a course of me- 



266 QUARTERLY PERISCOPE. 

dical lectures, or shall produce evidence of having been reputably engaged in 
the practice of medicine for three years previously to the last Tuesday of May, 
1824, shall be admitted a member of the society. The 9th section provides for 
the election of a treasurer, and points out his duties. Section 10 requires " that 
every person who may be hereafter licensed to practice physic or surgery in 
this state, shall deposit a copy of his license with the clerk of the court of com- 
mon pleas, in any county wherein he may reside; and until such copy shall 
be so deposited, he shall be liable to the penalties of this act, in the same 
manner he would be liable, if he had not obtained such license? and he 
shall pay to the clerk with whom he shall file such copy, twenty-five cents 
for filing and preserving the same, which it is hereby made the duty of such 
clerk to do," Section 11 provides that no person other than the mem- 
bers of the medical society, shall, after the 1st day of July, 1824, be permitted 
to practice medicine and surgery in the state of Ohio, under a penalty of ten 
dollars for every violation. The 12th section provides that the society shall 
never fix the amount of compensation to be charged for professional services 
or for medicine. The 13th section requires the medical societies to hold a meet- 
ing for the election of a delegate to represent the society in a general conven- 
tion. The 14th section requires that the delegates elected as provided in the 
preceding section, shall convene at Columbus on the second Monday in De- 
cember, 1827, to organize themselves, and to determine the expediency of esta- 
blishing a general medical society of the state, &c. Section 15 provides that 
the act shall not be construed so as to affect those who have been practising in 
the state previous to January 15th, 1821. Section 16 provides that the general 
medical society, when formed and organized, shall be a body politic and cor- 
porate. Section 17 repeals a law regulating the practice of physic, passed in 
January, 1821. 

At a General Representative Convention, held in the town of Columbus, in 
the month of December, A. D. 1827, agreeably to an act of the General As- 
sembly of Ohio, entitled, " An act to incorporate Medical Societies, for the 
purpose of regulating the practice of physic and surgery in this state," it was 
deemed expedient to establish a General Medical Society of the state of Ohio, 
in order to produce uniformity and efficacy in the proceedings of the District 
Medical Societies, and for the promotion of medical science: the following 
Constitution was adopted for the government thereof. 

Article I. Sec. 1. The General Medical Society shall be composed of re- 
presentative and honorary members. 

Sec. 2. The representative members shall consist of one representative from 
each of the District Medical Societies who shall be chosen on the last Tuesday 
of May; and on their being convened in consequence of the first election, they 
shall be divided by lot, as equally as may be, into two classes; the seats of the 
delegates of the first class shall be vacated at the expiration of two years; and 
those of the second class at the expiration of four years; so that one-half thereof, 
as nearly as possible, may be chosen biennially forever thereafter. And all 
vacancies which may occur in the representative members, shall be supplied 
by the District Medical Societies. 

Sec. 3. The honorary members shall be chosen by the General Medical So- 
ciety, from time to time, as they shall think proper, and shall be entitled to all 
the privileges of representative members, that of voting and receiving com- 
pensation for their services, excepted. 

Article II. The Society shall meet biennially, in the town of Columbus, on 
the first Monday in January; and a majority of representative members shall 
constitute a quorum for the transaction of business. The first meeting shall be 
the first Monday in January, one thousand eight hundred and twenty-nine. 

Article III. Sec, 1. At the opening of each stated meeting, the "Society 
shall proceed to elect from among the representative members, a President, 
Vice-President, Recording Secretary, Corresponding Secretary, and Treasurer; 
who shall hold their offices for two years, and until their successors are chosen. 



- 



American Intelligence. 261 

All elections shall be by ballot; and each representative member shall be en- 
titled to one vote. 

Sec. 2. The business of the meeting" shall be concluded by a discourse or 
dissertation on some medical subject, to be delivered by a person appointed at 
the stated meeting preceding. 

Article IV. The President shall have power to call special meetings of the 
Society, whenever its officers, or a majority of them shall deem it necessary; 
in which case, public notice shall be given in some newspaper, as specified for 
the stated meetings; and also special notice shall be served, through the me- 
dium of the post office, on all representative members of the Society, at least 
six weeks before the time of meeting. He shall have power to fill all vacancies 
in office, that may occur during the recess of the Society; he shall appoint 
committees, regulate debates, put questions, enforce an observance of the laws 
and regulations, have a casting vote on all questions before the Society, and 
perform such other duties as may be assigned him. 

Article V. The Vice-President, in case of the death, resignation, disability, 
or absence of the President, shall hold and exercise all the powers set forth in 
the preceding article, until a new choice of President. 

Article VI. The Recording Secretary shall have charge of the laws, records, 
and seal of the Society; shall notify the chairman of committees, furnish ne- 
cessary papers, and the names of the committees. He shall give six weeks 
previous notice of the stated meetings of the Society, in some public paper 
printed in Columbus, and perform any other services required of him by the 
Society. 

Article VII. The Corresponding Secretary shall have the charge of the 
letters and communications transmitted to this Society; shall cause all papers 
written in a foreign language to be translated into English; shall, under the di- 
rection of the President, answer all communications made to the Society; shall 
notify the District Societies of all resolutions governing them, passed by the 
Society; notify all honoraiy members of their election; and shall perform all 
such duties as may be assigned to him by the Society. 

Article VIII. The Treasurer, before entering upon the duties of his office, 
shall give bond with sufficient security, conditioned for the faithful perfor- 
mance of his official duties, in such sum as the Society shall direct; which 
bond shall be approved by the Society, and deposited with the Recording Se- 
cretary. He shall account to the Society for all moneys, and on the first day 
of each stated meeting, shall exhibit an accurate statement of his accounts to 
the Society. He shall pay out no moneys without the order of the presiding 
officer, and consent of the Society. 

Article IX. Any officer of the Society may resign his office, or be removed 
therefrom, for neglect or mal-conduct in office. 

Article X. The Society shall, from time to time, determine the amount of 
revenue to be raised, which shall be derived from uniform taxation upon all 
licences granted by the District Societies; and, if necessary, upon the indi- 
vidual members thereof. It shall also determine the amount of compensation 
of its own members, which shall be paid out of the treasury of the Society. 

Article XI. This Constitution may be revised, altered, or amended, by a 
vote of two-thirds of the representative members present, at any stated meet- 
ing of the Society. 

A code of by-laws has also been adopted by the society, and also uniform 
rules and regulations for the government of the district medical societies, and a 
code of medical ethics. Want of space will not permit us to insert these at 
present. 

Select Medico- Chirurgical Transactions. — Messrs. Caret & Hart will shortly 
publish under this title, a volume of memoirs, consisting of the most interesting 
communications read to the Medico-Chirurgical Societies of London and Edin- 
burgh, the Association of Fellows and Licentiates of the King and Queen's Col- 



268 QUARTERLY PERISCOPE. 

lege of Physicians in Ireland, the Medical and Physical Society of Calcutta, 
the Royal Academy of Medicine, the Medical and Anatomical Societies of 
Paris, and of the medical papers communicated to the Royal Societies of Lon- 
don and Edinburgh, the Royal Academy of Sciences of Turin, &c. &c. &c. A 
volume will be published occasionally as materials shall offer; every volume 
however will be complete in itself. In the selection of the articles, reference 
will be particularly had to their practical importance and permanent value; and 
in all cases they will be given entire, without any abridgment. 

The utility of such a work must be evident. Every one acquainted with the 
medical literature of the day, is aware that the memoirs read to the various 
medical societies constitute one of its most valuable and important portions. 

It is well known that in Europe, especially in England, the most common ex- 
pedients resorted to by young men to obtain practice, is to publish a book on 
the treatment of some disease, or on the use of some remedy, with cases, (not 
a few of which, there is reason to believe, are sometimes manufactured for the 
occasion,) illustrating the author's successful treatment of some disease, or of 
his new and advantageous employment of a certain medicine. With the slight- 
est ingenuity, and by the aid of large type and wide spaces between the lines, 
a goodly sized volume is readily got up, is advertised in every book, magazine 
and newspaper, and even should the work remain unsold on the booksellers 
shelves, it has been found that though the author has paid much for his adver- 
tisement, the practice he obtains by it fully compensates him. We must not 
be understood as saying that this is the history of all the works published at the 
present day, but it is that of a great number of them, as we have found to our 
cost; for after wading through volumes we have with difficulty been able to 
glean enough to fill a page in our Bibliographical Notices. 

The memoirs read to the Societies and Academies are of a very different or- 
der. They are mostly the production of experienced men, who despise or 
have no occasion to resort to the expedient just alluded to, or who have not 
time or disposition to write a volume. The value of these memoirs is further 
secured by the circumstance, that their character involves that of the societies 
in whose transactions they appear; these institutions are therefore careful never 
to sanction by publication any which are not calculated to reflect credit upon 
themselves. As no object is to be gained by unnecessarily extending such 
papers, they are usually perspicuous, and there is often great difficulty in giving 
a snort analysis of them, and sometimes it is even impossible. Thus it cannot fail 
to strike any one who will look over the various European Journals, that while a 
work of several hundred pages is dismissed in an analysis of a page or two, 
many times that space is devoted to an analysis of one of these short memoirs. 
This work will constitute an excellent companion to this and other Journals, as it 
will contain such papers only, as we find it impossible to give a complete ana- 
lysis of, or which it is of importance should be read in the author's own words. 

A Cyclopaedia of Practical Medicine, comprising treatises on the nature and 
treatment of diseases, materia medica and therapeutics, medical jurisprudence, 
&c. edited by John Forbes, M. D. F. R. S., Alexander Tweedie, M. D., and 
John Conoley, M. D., assisted by many of the most distinguished physicians in 
Great Britain, is preparing for publication in England. An American edition 
of this work will be published by Messrs. Caret & Lea, who have engaged the 
assistance of many of the most eminent physicians to revise and adapt it to this 
country. It will make about five volumes 8vo. similar to the Encyclopaedia 
Americana, and will be published at intervals of three months. A detailed 
prospectus will be shortly published. 

Oration delivered before the Philadelphia Medical Society, Feb. 19, 1831. — The 
annual oration before the Philadelphia Medical Society was pronounced this 
year by Thomas Harris, M. D. and has been published by the Society. The 
influence of exercise in promoting health, the subject selected by the orator, 



American Intelligence. 269 

is one of extreme interest, and the observations of Dr. H. in relation thereto, 
are characteristic of the good taste, sound sense, and practical mind of the au- 
thor. This essay may be read by every one with advantage, and we hope it 
will be extensively circulated. 

A Charge addressed to the Graduates in Medicine of the University of Pennsyl- 
vania, at the public commencement held in the College Hall, on Thursday, March 
24, 1831. By Win. H. De Lancet, D. D. Provost of the University. — The gra- 
duates have done well in publishing this eloquent address, and they cannot too 
deeply engrave on their minds the excellent precepts it contains. 

Coloured drawing of the great Sympathetic Nerve. By J. P. Manec, D. M. P. 
Lecturer on Anatomy and Operative Surgery at Paris. Copied on stone by P. 
Ancora, Teacher of Drawing and Painting, Philadelphia. Letter press translated 
and corrected by J. Pancoast, M. D. — Every physician should possess a copy of 
this splendid plate. It is impossible to understand the functions and deranged 
conditions of some of the most important organs without an acquaintance with 
the anatomy of the sympathetic, while the difficulty of making out the ramifi- 
cations of that nerve on the dead body, is so great, that none, except the most 
experienced anatomists are able to accomplish it. In this plate the whole are 
delineated, and Mr. Ancora has conferred a benefit upon the profession by its 
publication. With this plate before them, our readers may reperuse the ana- 
lysis of Lobstein's work on the great sympathetic nerve in our fifth volume with 
great advantage. 

Broussais's Histoiy of Chronic Inflammation. — A translation of this work which 
has been pronounced to be "a model of knowledge and originality in medi- 
cine," is in the press and will be published in a few weeks by Messrs. Carey & 
Lea. 

Thompson's Lectures on Inflammation. — This valuable work has been for some 
time entirely out of print both in Great Britain and this country. The enqui- 
ries that have constantly been made for it, have induced Messrs. Carey & Lea 
to republish it. 






Colles's Surgical Anatomy. — Messrs. Carey & Lea have published a second 
edition of this excellent work, with notes by J. P. Hopkinson, M. D. Demon- 
strator of Anatomy in the University of Pennsylvania. 

Manual of Pathology. By L. Martinet. — Messrs. Carey 8c Lea have pub- 
lished a second edition of the translation of the valuable Manual of Pathology 
by Dr. Martinet. 

New Books in the Press. — Messrs. Carey & Lea have in the press Dr. James 
Johnson's new work on " Change of Air, or the Pursuit of Health,- an Autumnal 
Excursion through France, Switzerland, and Italy," &.c, Tweedie on Fever, and 
Farrady on Chemical Manipulation. The last will be enriched with notes by 
J. K. Mitchell, M. D. Lecturer on Chemistry in the Medical Institute. 

University of Pennsylvania. — The number of students in this institution on the 
1st of January last, was 774, of whom 410 were attending the medical lectures. 

Medical College of South Carolina.— The number of students in this institution 
during the past winter was 131. 

Medical College of Ohio. — The number of medical students during the last 
session was 140. 

No. XV.— May, 1831. 24 



270 QUARTERLY PERISCOPE. 

New Analysis of Swaim's Panacea. — Just as this form was preparing for press, 
we received from Dr. J. Rose of this city, an account of an analysis made by 
him,^under the superintendence, and in the laboratory, of Professor Hare, of the 
contents of a bottle purporting to be " Swaim's Panacea." In this analysis both 
mercury and arsenic are said to have been detected. We have already published 
the statements of three different chemists, by whom mercury was found in Swaim's 
Panacea,* but it had not been before examined, we believe, for arsenic; at any 
rate, so far as we know, this is the first time that the presence of that poison has 
been detected in it by chemical analysis. We have long been satisfied, however, 
of the variable composition of the panacea, and it seems probable that it some- 
times contains both the corrosive sublimate and arsenic; sometimes only one of 
them, and at others neither. So perfect have become the processes of modern 
analytic chemistry, that it is almost impossible for the minutest particle of a mi- 
neral substance to elude the scrutiny of the skilful analyst, and it is in vain now 
for the empiric to think to conceal his poisonous drugs by mixing them with sy- 
rups and saccharine matters. 

The communication of Dr. Rose is accompanied with several affidavits made 
for the purpose of showing that the matter analyzed was the remains of a bot- 
tle obtained from Swaim, by a man named James Hill, for the cure of an 
ulcer on his leg; that the said James Hill, on the third day after commenc- 
ing to use the medicine, four wine-glasses full only having been taken, died 
with vomiting of blood; that the deceased, after taking the medicine, com- 
plained that it burned him to the heart; and that the remainder of the contents 
of the bottle were carefully preserved by his friends until given for analysis. 

We regret that the late period at which the communication of Dr. Rose and 
the accompanying documents were received, prevents our publishing them in 
the present number. 



NECROLOGY. 

It is with regret that we have to announce the death of Benjamin Ellis, 
M. D. Professor of Materia Medica and Pharmacy in the Philadelphia College 
of Pharmacy, and editor of the Journal of that institution. 

We have also to record the death of the distinguished Professor of Chemis- 
try in the University of Maryland, Eeisha De Butts, M. D. one of the colla- 
borators of this Journal. 

The College of Physicians and Surgeons of New York have lately been de- 
prived by death of their president, Dr. Watts. 

We hope that the friends of these distinguished physicians will furnish us 
with short biographical notices of them. 

* See Vol. IV. p. 530, and Vol. V p. 262 and p. 542, of this Journal. 



Faqe.349 



American Journal of iTLeclical/ Sciences? 

FJ7.nr. voi.virr, 










nramifram yiature.Si^ng'd it JJIraytmi. 



THE 

AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



PRIZE ESSAY. 

Jit the Annual Convention of the Medical and Chirurgical Faculty of Mary- 
land, held in Baltimore, June 6th, 1831, the following report was submitted by 
the Prize Essay Committee, and accepted by the Convention. 

JOHN FONERDEN, Bee. Sec. 

The Committee appointed by the Medical and Chirurgical Faculty of Mary- 
land, at the last convention to award the medical prize — 

Report, That in the performance of their duty, they selected for the subject 
of the Prize Essay, " The nature and sources of Malaria, or noxious miasma, 
from which originate the family of diseases, usually known by the denomination of 
bilious diseases,- together with the best means of preventing the formation of mala- 
ria, removing their sources, and obviating their effects on the human constitution, 
when the cause cannot be removed." As was expected, from the great importance 
of the question, many highly respectable essays were presented. Several of 
them deserve special commendation for ingenuity and research. Your commit- 
tee, in the execution of their assigned duty, have adjudged the prize to that 
bearing the superscription — 

" Dieserrorem delet, veritatemque illustrat." 

The committee, however, respectfully suggest that the other competitors for 
the prize be requested to give publicity to their productions. The subject of 
malaria is one of great concern to the world at large, and the results of concen- 
trated investigation are too valuable to be lost, when so much information re- 
mains unsupplied. Charles Caldwell, M. D. of Kentucky, is the author of the 
successful essay. 

THOMAS E. BOND, M. D. 

JOHN BUCKLER, M. D. 

JOHN FONERDEN, M. D. 

H. WILLIS BAXLEY, M. D. 

EDMUND G. EDRINGTON, M. D. 

JOHN L. YEATES, M. D. 

PETER SNYDER, M. D. 
No. XVI.— August, 1831. 26 



294 Caldwell on Malaria. 

Art. I. An Essay on the Nature and Sources of the Malaria or Noxi- 
ous Miasma, from which originate the Family of Diseases, usually 
known by the denomination of Bilious Diseases; together with the 
best means of Preventing the Formation of Malaria, removing the 
Sources, and obviating their Effects on the Human Constitution, 
when the Cause cannot be removed. By Charles Caldwell, 
M. D. Professor of the Institutes of Medicine and Clinical Prac- 
tice in Transylvania University. (Published at the request of the 
Medical and Chirurgical Faculty of Maryland. ) 

" Dies errorem delet, yeritatemque illustrat." 

1 HE entire subject of this dissertation, as proposed by the Faculty 
of Maryland, is included under the four following questions: — 

1. What is the nature of the malaria that produces bilious fever ? 

2. From what source or sources does it arise ? 

3. What are the best means of preventing its formation and re- 
moving its sources? and when the sources cannot be removed, nor 
the formation prevented, 

4. How may its effects on the human system be most certainly 
obviated ? 

These questions I shall now consider in the order in which they 
are here proposed, treating each of them as succinctly as the subject 
will admit. 

1. What is the nature of the malaria that produces bilious fever? 

To this question my answer is brief, i" do not know. Nor is any 
one better informed about it than myself. The present state of sci- 
ence does not admit of better information. By no other test than its 
deleterious effects on the animal kingdom, more especially on man, 
can even the existence of the poison be established. Of its nature or 
composition, or the species of matter to which it belongs, no more is 
known than is of the poisons of small-pox, measles, or rabies canina. 
Here the matter, for the present, might be suffered to rest, were it 
not that multiplied errors respecting it are afloat, the exposure of 
some of which would seem, in its beneficial effectSj to be second only 
to the discovery of truth. 

The malaria of bilious fever is supposed, no doubt correctly, to be 
the product of chemical agency. The votaries of the laboratory, 
therefore, have endeavoured to make it the subject of chemical ex- 
periment. But in no instance have they succeeded. Virtually they 
have sought a phantom and found nothing. Their efforts have been 
as unavailing as those of the child that pursues its shadow or grasps 



Caldwell on Malaria. 295 

at a moon-beam. I speak from personal observation. I have often 
witnessed these attempted experiments, and sometimes engaged in 
them myself, with equal interest and disappointment. They were 
tried on the atmospheres of different places, where bilious diseases 
prevailed in every grade from a slight intermittent to malignant 
yellow fever. But they were tried to no purpose. In the air where 
man contracted disease soonest, more certainly, and of the worst 
character, no more poison of any kind was discoverable than in the 
healthiest atmosphere of the hill top or the mountain. Nor could any 
extraneous matter, in the form of gas or otherwise, be detected in the 
one body of air more than in the other. In each, all the common at- 
mospherical components were present in their natural proportions; 
and nothing else appeared. Neither a deficiency of oxygen, there- 
fore, nor a superabundance of carbonic acid gas, or of any other 
known chemical compound, could be indicated as the cause of the 
prevailing sickness. That evil was the product, as already mention- 
ed, of a lurking agent, whose very existence could be recognised 
only by the injury it inflicted on animated nature. 

But, as relates to the nature of bilious malaria, the influence of 
chemistry has not been merely negative. It has not only failed to 
confer any benefit on the medical profession; it has proved to it a 
source of positive mischief. This it has done by becoming a hot-bed 
of hypotheses, to the exclusion of observation and sober inquiry. 
During the late domination of ultra chemistry, when the entire sys- 
tem of man was considered a chemical laboratory, and almost every 
science was adulterated by the caloric of the crucible or the fumes 
of the retort, it was impossible that malaria should not be consider- 
ed a product of the same source. And as some chemists affected a 
knowledge not only of all the elements, but also of all the combina- 
tions of matter, it was inevitable that they should attempt to identify 
the poison in question with one or other of the gases formed by their 
experiments. From this arose a state of things which seemed to pro- 
claim that the only province of chemical physicians was to deal in 
conjecture. And their art was practised indiscriminately on the phe- 
nomena of living and dead matter. Hence, as respected malaria, the 
brain of every member of that school, brought forth its own peculiar 
fancy, until, collectively, the motley brood almost equalled in num- 
ber, and quite in ludicrousness, the fables of iEsop. Every single 
gas, with every imaginable mixture of gases, was proclaimed, in its 
turn, or rather in a simultaneous and promiscuous uproar, (no can- 
didate for the honour of discovery waiting for or listening to a com- 
petitor,) to be the miasm productive of bilious fever- But as far as I 



296 Caldwell on Malaria. 

remember, (for I was not so much edified or delighted by the tumult 
as to treasure up all that transpired in the course of it,) public atten- 
tion was longest and most forcibly attracted by the claims of the ni- 
trous oxide or some other nitrous compound, and carbonic acid gas. 
These found many advocates, some of them distinguished for ability 
and eloquence, who made it, for several years, their daily study and 
nightly toil, to prove them the source of bilious complaints. Yellow 
fever was, at the time, prevailing annually in our large commercial 
cities. An effort was made, characterized by much ingenuity, and 
urged with a degree of industry and perseverance worthy of a better 
cause, to derive that malady from nitrous oxide or some other gas 
whose base was nitrogen. The New York Medical Repository con- 
tains many papers in defence of this hypothesis, some of which were 
marked with much research, and an unusual share of strength and 
dexterity in argument. But they were written to no purpose. Na- 
ture has decided that fact must prevail, and that all else is perisha- 
ble and evanescent. However attractive and imposing the form and 
colouring that talent and labour may bestow for a time on hypothesis 
and error, they cannot establish them on the ruins of truth. The ni- 
trous oxide notion, therefore, had its day. But it was short. He- 
cords only say of it that it was. Present opinion says it is no more. 
Two well known facts ought to have been sufficient to stifle it in 
Its birth. No mode of applying nitrous oxide or any other nitrous 
compound to the human body, can produce yellow fever. The expe- 
riment was repeatedly made during the period referred to, and uni- 
formly failed. Nor could a particle of the gas in question be detect- 
ed in the atmosphere of the places where its supposed product pre- 
vailed. Other objections might be added; but they would be super- 
fluous. 

Although still more palpably erroneous, not to say absurd, the hy- 
pothesis attributing bilious fever to carbonic acid gas has yet some 
advocates. But they are not numerous. Why they ever had an 
existence among physicians possessing any knowledge of that gas, is 
to me unaccountable. Its presence in the atmosphere is easily de- 
tected. But experiment proves that it does not exist in unusual 
quantities, in places where bilious diseases prevail. Much less does 
it exist in quantities proportioned to the amount of disease. If the 
report of a distinguished physician may be credited, the reverse is 
sometimes true. It is found in a comparatively diminished quantity 
In places of sickness. Fort Fuentis stands in a marshy and sickly 
district, at the mouth of the Valentine. Mount Legnone, one of the 
chain of the Grison mountains, which rises 8640 feet, French mea- 



Caldwell on Malaria. 297 

sure, above the level of the sea, is peculiarly healthy where it is in- 
habited, and its summit is covered with perpetual snow. In these 
places, when fever was raging in the low country, Gattoni made re- 
peated experiments, and found, to his surprise, that, chemically 
speaking, the sickly atmosphere was the purest of the two. In other 
words, it contained the greatest amount of oxygen, and of course a 
diminished proportion of its other elements. The positive quantity 
of carbonic acid gas in each place was the same. For the accuracy 
of these experiments I am unwilling to vouch. I have already men- 
tioned that those of a similar nature, in which I have been myself 
concerned, gave a different result. They indicated no difference be- 
tween a healthy and a sickly atmosphere. The result of a series of 
experiments by Moschati was the same. 

But this is not all. Every one knows that, in whatever way it 
may be applied, the effects produced on the human system by carbo- 
nic acid gas, are totally different from those that result from bilious 
malaria. No two classes of phenomena can be more dissimilar. 
Measles and influenza, scarlatina and small-pox, are much more 
alike. Were the hypothesis I am opposing true, the attendants on 
lime-kilns, where immense quantities of carbonic acid gas are hourly 
evolved, would never be free from bilious fever. Nor would the 
complaint fail to attack us by our fire-sides, especially in winter, 
when we consume oil in our lamps, and spermaceti in our lustres. 
Every Laplander's hut, moreover, during his long night of winter, 
would be a fruitful laboratory of febrile malaria. Yet throughout 
that period, in particular, he is a stranger to the complaint which 
that poison produces. Even the chemist in his laboratory, when 
preparing carbonic acid gas, would frequently suffer from his own 
experiments. In a more especial manner, were the notion true, what 
would become of our porter, ale, cider, champaigne, and soda- 
water drinkers, who are swallowing by the hour, deep potations of 
the reputed miasm? In that case, every butt of beer would be fraught 
with the seeds of bilious fever, and every brewery and soda-water 
fountain, as rich in poison as the Pontine marshes. The hypothesis 
is ludicrous, and were it not that it has received the sanction of phy- 
sicians of standing, would be unworthy of a moment's serious con- 
sideration. 

Another chemical notion respecting the cause of bilious fever, de- 
serves, perhaps, a passing notice. It is that which attributes the 
disease to the hypercarbonation of the blood. This again, I say, is 
as empty a conjecture as has ever issued from the dreams of a visionary. 
The blood of patients in bilious fever, say its advocates, is always 

26* 



298 Caldwell on Malaria. 

preternaturally dark-coloured, from holding in mixture a super- 
abundance of carbon. Neither this position itself, nor the attempted 
explanation of it is true. As a general rule, the blood of patients in 
bilious fever is not preternaturally dark. It assumes that colour only 
under particular circumstances, which have no connexion with the 
amount of carbon in it. They are explicable only on a very differ- 
ent ground; and on that their explanation is easy. I venture to say t 
moreover, that the venous blood in bilious fever is more frequently 
preternaturally florid, than preternaturally dark. During the stage 
of excitement, if the reaction be strong, and the circulation free, 
its colour is always too high. Nor am I the first writer who 
has said so. The fact is recorded by Riverius, Cleghorn, and 
Huxham; and, if I mistake not, also by Sydenham and Rush; and 
I am confident it must have been witnessed by thousands of others. 
I doubt whether there is a practised bleeder in the United States, to 
whom it is not familiar. During the access and cold stage of in- 
termitting fever, the blood is always dark, but becomes florid again 
in the stage of excitement. It is also dark in deeply congestive 
bilious fever, where reaction is suppressed; but in open fever of high 
excitement, the reverse is true. In fact, in every case where the 
circulatory system is torpid, or in any way wanting in action, and res- 
piration deficient, the blood is, and by the laws of the animal economy 
must be preternaturally dark. But it never is, nor can be so, when 
circulation and respiration are vigorous and free. Were it admissi- 
ble for me to dwell on it, all this is perfectly explicable, on princi- 
ples which no physiologist would controvert. Nor has carbon any 
more connexion with the phenomenon, than it has in giving fragrance 
to the rose, or lustre to the sun. That it should, by intelligent phy- 
sicians, be supposed to have, is matter of surprise. 

Have chemists detected, by a fair and satisfactory analysis, a su- 
perabundance of carbon, in dark venous blood? Have they detected 
in it a particle more than is found in the florid blood of the arteries? 
The annals of their profession cannot reply to these questions in the 
affirmative. Or if they can, I know not where the record is to be 
found. Conjecture indeed has said yes; but fact has not concurred 
with it. Again: does a mixture of carbon with bright arterial, con- 
vert it into dark venous blood ? No physician of reputation will con- 
tend that it does. I, on the contrary, assert that it does not. I 
have witnessed the experiment, and .know that I speak correctly. 
The hypothesis is but an abuse of animal chemistry which should re- 
ceive no countenance from real physiologists. Were I to say the 
same in general of chemistry, as applicable to the functions of living 



Caldwell on Malaria, 299 

matter, I might set opposition at defiance. It neither performs any 
of them, nor aids in the performance. Within its proper sphere, 
that science is delightful and important. None can be more so. 
But it is concerned exclusively with dead matter. With life and all 
its attributes it is at war. It is the great antagonist of life, and life 
of it. It is no more suited to explain a single function of living 
matter, than the laws of life are to explain the formation of carbonate 
of magnesia, or Glauber's salt. When an attempt is made to ex- 
pound by it a vital phenomenon, it is dislocated and misapplied; and 
that dislocation, like every other, proves a source of mischief. The 
harmony of nature consists in every thing producing after its kind. 
Abrogate this law, and chaos is recalled. Chemical causes, there- 
fore, can produce only chemical effects, and vital causes vital effects, 
They are not transmutable in themselves or their action. Physiolo- 
gists would escape an infinity- of trouble, and the profession no less 
confusion and error, were chemists to confine themselves to their 
proper laboratories, and to dead matter. The living body of man is 
as completely without their sphere, as its structure and economy are 
beyond the imitation of the manufacturer of chess-playing automatons, 
and rone-dancing harlequins.* 

* It is in vain for M. Broussais, and other animal chemists, to endeavour to 
explain away the error they propagate and the mischief they do, by the terms 
they employ. To tell us that, by "animal and vegetable chemistry," they 
mean the mutual action, in the form of decomposition and recomposition, of 
the "radical molecules of organized matter, under the controul of the vital prin- 
ciple" is of no avail, as to the object they profess to have in view. Chemistry 
is a technical word, possessed of a definite meaning 1 . For centuries it has been 
the representative of certain changes in the composition and qualities of matter, 
produced by affinity and repulsion, under the influence of given laws. Nor is 
there between those changes and the phenomena of life the slightest similarity. 
They are, on the contrary, the antipodes of each other. Dissimilitudes stronger 
than those which exist between them can scarcely be imagined. 

Yet when the changes in living matter are said to be produced by " animal 
chemistry, 5 ' nine persons out of ten, I might say ninety-nine out of a hundred, 
attribute them to the agency of the common chemical affinities; I mean the 
chemical affinities of the laboratory. They consider respiration, digestion, and 
other vital functions as belonging to the same class of processes, with the com- 
bustion of charcoal, the decomposition of water, and the formation of neutral 
salts. 

Thus is error propagated by an improper use of words. Nor does there exist 
for that use the slightest necessity. The expressions, animal action, vegetable 
action, or the more general one, vital action, would be much better than ani- 
mal, vegetable, or vital chemistry. The former, although not explanatory of any 
thing, do not mislead; whereas the latter do. I need scarcely add, that e very- 
phrase which propagates error ought to be erased from the language of science 



300 Caldwell on Malaria. 

There are not wanting chemical physicians who would identify yet 
other gases with the malaria productive of bilious fever. Of these 
substances some are sulphureted hydrogen gas, phosphoreted hydro- 
gen, and I believe carbonated hydrogen, with perhaps a few others. 
As relates to all of them, a single remark is sufficient to subvert the 
hypothesis which embraces them. Not one of them can be detected 
in the atmospheres of places where bilious fever prevails. Agitate, 
with a stick, the bottom of a pond, where masses of vegetable relics 
exist in a dissolving state, and some of them will indeed rise to the 
surface of the water, and may be ignited. But examine the atmos- 
phere only a few feet distant, and no trace of them will be found in 
it. To this may be added, as another objection, that no application 
of these gases to the human body can produce any form of bilious 
disease. 

Another hypothesis respecting the malaria in question, which has 
found advocates of some respectability is, that no such poison exists: 
but that bilious fever results exclusively from heat, moisture, and vi- 
cissitudes in temperature. My reply to this notion shall be brief, 
but I trust satisfactory. 

When yellow fever prevails in a city, it is often arrested in its 
progress, by the interposition of a street not more than sixty feet 
wide. It advances to the east or the north line of the street, but 
goes no further. Almost all the inhabitants on that side suffer; and 
all those on the opposite one escape. Such a case I have repeatedly 
witnessed, and therefore speak confidently of it. Many others hav^ 
witnessed it also. Of oriental plague the same is true. 

How is this phenomenon to be expounded? Place on each side of 
the street a thermometer, a barometer, it hygrometer, and a pluvio- 
meter, and they will show the atmosphere to be, in both places, pre- 
cisely alike in temperature, weight, and moisture, as well as in the 
changes it undergoes, and the rain it precipitates. To no difference, 
in these respects, then, can the difference in healthfulness be ascribed. 
But one source of solution remains. The disease arises from a subtle 
poison, which reaches the street, but does not cross it. A stream of 
water of moderate width has arrested the progress of sickness on the 
same principle. 

Again. Yellow or common bilious fever is raging along the bank of 
a large river, or some other body of navigable water, and a ship is 
lying in it, at cable's length from the land. Provided the vessel be 
kept clean, and her government be judicious, the crew will continue 
healthy, unless they are permitted to visit the shore; in which case 
they will suffer from the prevailing disease. This is a common oc- 



Caldwell on Malaria. 301 

currence, which no difference in the sensible qualities of the atmos- 
phere can explain. No difference indeed exists in them. At the 
edge of the water, and seven hundred feet distant from it, where the 
ship lies, those qualities are the same. But there is a miasm at the 
former place, which does not reach the latter; and hence the differ- 
ence, as relates to disease. 

Some of those who deny the existence of malaria, attribute bilious 
fever to the deleterious influence of atmospherical moisture aloneo 
Were this hypothesis true, no maritime situation could ever be 
healthy. The atmosphere of such places being necessarily surcharg- 
ed with humidity, bilious fever would be an annual scourge to them. 
It would be rather perennial, prevailing during the winter as well as 
the summer; the atmosphere being humid throughout the year. But 
if free from swamps and marshy ground, maritime situations are pe- 
culiarly healthy. Of insular places, especially small ones, the 
same may be said. The marine air sweeping entirely across them, 
their atmosphere is saturated with moisture, and often darkened by 
fogs; and yet they are among the healthiest spots on earth. Bermuda, 
the Bahamas, and particularly most of the Scottish isles are of this 
description. The atmosphere of a vessel at sea is necessarily very 
humid. Yet, provided she be clean and well-governed, she is always 
healthy. To neither humidity, then, nor any other sensible quality 
of the atmosphere, can bilious fever be reasonably ascribed. It is 
the product of an aerial poison, significantly enough denominated 
malaria, whose effects alone on the animal kingdom proclaim its ex- 
istence. 

2. From what source or sources does bilious malaria arise? 

From vegetable and animal matter, more especially the former, in 
a state of dissolution. I say "dissolution," not putrefaction; be- 
cause there is good reason to doubt whether that process, in the 
technical meaning of the term, be necessary to the result. Bilious 
fever, in all its varieties of type and degree, often prevails in places 
where no putrefaction is discoverable. But dissolution, by which I 
mean the decomposition of dead organic substances, and the reunion 
of their elements, producing new compounds, is present. In no other 
way can the malaria be formed. At least it never manifests itself, 
except in situations where traces of the process referred to appear. 
That my remarks may be the better understood, when I shall speak 
hereafter of the prevention of this miasm, I must treat of its produc- 
tion somewhat circumstantially. 

The medical world is in the habit of referring to Lancisi as the 
discoverer of the malaria of bilious fever. In a certain view of the 



302 Caldwell on Malaria. 

subject, I have already admitted that the reference is correct. He 
was so far the discoverer of it as to be the first to pronounce it the 
azotic or lifeless result of the chemical dissolution of vegetable and 
animal substances, and to bestow on it a name expressive of what 
he considered its nature. Others, who had spoken of it, believed it 
to be, as will appear presently, not dead matter, but a countless 
brood of animalculae, infinitely small. He called it paludum efflu- 
vium— -marsh exhalation — because he believed a marsh, lake, or 
some other form of stagnant water necessary to its production. But 
he was far from being the first to indicate fens and marshes as send- 
ing forth, directly or indirectly, vapours and other kinds of matter 
productive of bilious and pestilential diseases. In expressing their 
conviction of the pestiferous influence of such places, the ancients 
were as clear and decided as he was. But they spoke in poetry, he 
in prose 5 they in the language of fiction, he in that of philosophy. 
Each treated the subject in the spirit of the age in which he lived. 
Had he been an ancient Greek or Roman, he would have derived the 
poison from the breath of the Python, or the Hydra, (two words 
which, united, signify putrid water,) and had Celsus or Galen lived 
at the beginning of the eighteenth century, either of them \0uld have 
pronounced it the result of the dissolution of organic matter. So true 
is it that men often attain to high renown, for promulgating opinions 
and doctrines believed to be entirely their own, but which, in fact, 
belong, in a great measure, to the periods in which they live. Their 
predecessors had sown the seed, and they appeared at the proper 
season to reap the harvest. Had they not been born to do it, others 
more fortunate would. This is true of every discoverer, however 
illustrious. Had neither Columbus, Newton, nor Franklin seen the 
light, others would have appeared about the same times they did, to 
discover a new world, unfold the laws of material creation, and prove 
the identity of electricity and lightning. 

Centuries before the time of Lancisi, true poetic fiction, respect- 
ing the cause of the pestiferous influence of marshes, had given place 
to what might be called philosophical hypothesis; I mean certain 
views or notions, which their authors believed to be true, but of which 
they had no substantial evidence. They were the grave but visionary 
conjectures of the cloisters, sanctioned by the solemn dogmas of the 
schools. They marked the transition state of the human intellect 
from real fiction to real philosophy. Many writers, before the age of 
Lancisi, declared the cause of bilious fever to be the offspring of pu- 
trefaction. But, as already observed, they deemed it animalcular. 
They were believers in equivocal or elementary generation. In their 



Caldwell on Malaria. 303 

opinion, therefore, putrefaction in marshes produced myriads of ani- 
malcule, too minute to be detected by our senses, or to become cog- 
nizable in any way, except by their effects on larger forms of living 
matter. These monads of life, as small and as numerous as particles 
of air, made their way into the human body by the pores of the skin, 
or in some other manner, mingled with the fluids, pierced and poi- 
soned the solids, and spread corruption through the whole. Then, 
propagating their like with wonderful fecundity, they issued from the 
bodies of the sick to invade those of the well, and thus the disease 
was rendered contagious. This hypothesis of animalcular contagion, 
however wild and irrational it may be deemed, has its advocates even 
now. Lancisi had only to exchange the generation of poisonous 
animalculee by putrefaction, for the generation of a poisonous gas, 
and his work was done. Nor does the exchange seem difficult. On 
the contrary, it was easy and natural, because all things were pre- 
pared for it. If he had not made it, therefore, somebody else would 
have done it in his place. 

Let it not be imagined that I mean by these remarks to detract 
from the just reputation of the illustrious Italian. Far from it. No 
one does Jiomage more sincerely than I do, to his talents and ser- 
vices. He was one of the great promoters of medical science of his 
day. But, had he lived at an earlier and darker period, he would 
have been less fortunate, because all things would not have been ma- 
tured for the discovery. He would not, therefore, have been the au- 
thor of it, but it would have been reserved for another. Hence, in 
what I have said respecting him, I only mean to give a correct re- 
presentation of the progress of the human mind in the attainment oi 
knowledge. This concerns the history of general science as well as 
of discovery, and should be known to every student of nature. 

Lancisi, then, finding opinion in the state just represented, ad- 
vanced it another step, by pronouncing the poison which had almost 
desolated the country around Rome, the issue of putrefaction, in the 
form of gas, instead of animalculse. Nor did he issue his belief in the 
shape of mere conjecture. He sustained it by an array of facts and 
arguments, which all his enemies and competitors for fame were un- 
able to shake. He was as fortunate in proving that bilious fever is 
the product of a poison resulting from the dissolution of dead organic 
matter, as Harvey was in proving the circulation of the blood j and 
he had certainly a more intricate subject to handle. As relates to the 
mere establishment of the fact, nothing material has been since add- 
ed; nor do I know that any thing such remains to be added, to what 
is contained in his admirable work, " De noxiis paludum effluviis." 



304 Caldwell on Malaria. 

The substance of all that has been said in support of the doctrine by 
subsequent writers, is there condensed in a style and manner that 
bespeak alike the strength and independence of the writer, the ac- 
complishment of the scholar, and the resources of the philosopher. 

But was Lancisi correct in the name he affixed to the malaria he 
discovered ? Is it really paludum effluvium? Is a marsh or fen ne- 
cessary to its production ? No, it is not; and much evil has arisen 
from the mistake of looking to such places alone for its formation. 
Thousands of individuals have fallen victims to the error. The Ita- 
lian discoverer convinced himself that it issued in abundance from 
the Pontine marshes, and the Campagna di Roma with its numerous 
ponds, and thence inferred that such collections of stagnant water 
were essential to its generation. But he was mistaken. The most 
terrific calamities it has ever produced, have occurred where there 
were neither fens nor marshes. Witness yellow fever in the cities of 
the United States, of the West India islands, of tropical America, 
and the south of Europe, and true pestilence in those of Asia and 
Africa. That the miasm is generated along the borders of marshes is 
true; but perhaps the bodies of such places never produce it. Or if 
they do, their water absorbs it again, and prevents it from doing mis- 
chief. That fluid has a strong affinity for it. Hence the centre of 
large swamps is often a place of health. Labourers in cypress swamps 
rarely suffer from bilious fever; the more especially when they are 
remote from the borders of them. 

Am I asked then, what is essential to the production of malaria? 
I answer, four elements, dead vegetable matter, a high temperature, 
atmospherical air, and water in moderation. What particular part 
of the process depends on atmospherical air I know not. But 
there is reason to believe that some part of it does. When speaking 
of the generation of the miasm, therefore, I shall always suppose the 
presence of air. In citing vegetable matter as one of the elements 
in the production of malaria, it is not my intention to exclude en- 
tirely animal matter, especially that of animals of the lower classes. 
It is quite probable that that may unite with vegetable matter in the 
process of dissolution, and aid in the general effect. My only object 
is to express my belief, that the latter is greatly superior in quantity, 
and therefore more extensively tributary to the formation of the 
poison. 

Whenever these elements meet in due proportion, and continue 
together a sufficient length of time, malaria is the issue. But if one 
or more of them be absent, the miasm is not formed. Is heat wanting 
as in winter ? No poison is generated. Is moisture wanting, as is the 



Caldwell on Malaria. 305 

case during part of the summer, in the Delta of the Nile? Malaria 
is also wanting, and health prevails. Is perfect cleanliness pre- 
served by the removal of all dead vegetable and animal mat- 
ter? The production of the poison is impossible. The same is true, 
if water super-abound, so as to flood the vegetable mass. Too much 
water is as fatal to the process, as perfect dryness. Hence, Egypt 
is healthy, while inundated by the Nile; and when, in consequence 
of inordinate rains, a marsh is entirely overflowed, it ceases for a 
time, to be a source of sickness. 

That malaria may be generated, it has been pronounced necessary 
that its elements be together ■" in due proportion," and " a sufficient 
length of time." But facts are wanting to warrant a decision, what 
either the exact " proportion," or the " time" should be. Observa- 
tion seems to teach us, that in the United States, the production of 
yellow fever requires at least a month's continuance of tropical heat. 
After that duration of such a temperature, unless the general consti- 
tution of the atmosphere forbid it, the danger becomes threatening. 
Such was certainly the case in the city of Philadelphia, during the 
pestilential period, which lasted from 1793 until 1805. Records can 
be produced to show, that throughout that term of years, yellow 
fever never failed to appear in greater or less extent, after the above 
mentioned continuance of tropical heat. Nor did it ever occur under 
a temperature of less intensity and duration. 

Does any one doubt whether the agents here cited are the real 
elements of bilious malaria? I reply, that the evidence to that effect 
appears conclusive, and that the doubt is therefore groundless. As 
already stated, wherever the agents referred to exist, the poison ma- 
nifests itself in the production of some form of bilious disease. And 
where they do not exist, no such manifestations are made. The 
more abundant the agents are, in due proportions to each other, the 
more extensive, and usually the more violent is the. complaint; and 
nothing but themselves is known to be necessary .to the effect, or in 
any degree auxiliary to it. Add, that the disease prevails more cer- 
tainly and generally in their vicinity, than at a distance from it, and 
the evidence I repeat would seem to be conclusive. But perhaps it 
may be the wish of some to have a few exemplifications on the sub- 
ject; if so, the following are submitted to them. 

In all large and crowded cities in the United States, and other 
warm climates, heat, moisture, and dead vegetable and animal sub- 
stances abound in mixture with each other, and unite in their action. 
The consequence is known. In such places, bilious complaints are 
an annual evil; and they are usually graduated by the amount of the 

No. XVI.— August, 1831. 27 



306 Caldwell on Malaria. 

agents which the places contain. It is believed that they would i>€ 
always thus graduated, did not a peculiar constitution of the atmos- 
phere at times interfere. Of the borders of swamps, marshes, and 
large rivers that overflow their banks, the same is true. There the 
elements of malaria are found in sufficient abundance; and there also 
disease prevails. Alluvion is composed, in part, of vegetable and 
animal relics; and in no portion of our country is either heat or mois- 
ture wanting. In every alluvial district, therefore, in the United 
States, the agents necessary for the production of miasm exist. Here 
again the issue is the same. Such places are visited annually by 
bilious complaints. The condition of health during summer and 
autumn, in the low grounds of all large rivers may be safely offered 
in proof of this. Again. Rich soil of every description, whether it 
be alluvial or not, contains, of necessity, a considerable portion of 
animal and vegetable remains. On these alone its fertility depends. 
Such soil then, is copiously impregnated with one material of miasm, 
greatly comminuted, and in a state of high preparation to cooperate 
with the others. Nor is there any climate where heat and moisture 
are always wanting. Hence, in every region, fertile districts are 
visited at times by bilious complaints. To this it is believed that 
the chart of the world does not present a single exception. The 
event occurs more uniformly and distressingly, and is therefore more 
noticed in warm climates. But it occurs more or less in every re- 
gion inhabited by man. Although the fervours of the line peculiarly 
favour it, the rigors of the north do not forbid it. Were I inclined 
to moralize, I might say that it seems like an impartial provision of 
nature, to counterbalance the advantages of a fertile soil and render 
all places nearly equal, as respects the enjoyments and happiness of 
their inhabitants. 

The reverse of the picture here presented is not less favourable to 
the opinion I am maintaining. In the soil of sandy plains, remote 
from rivers, lakes, and other large bodies of water, and somewhat 
elevated, vegetable and animal relics have scarcely an existence. 
Nor are malaria and its effects the scourge of such places. What- 
ever may be the amount of heat and moisture they experience, the 
inhabitants are exempt from bilious fever. The reason is, the absence 
of vegetable and animal remains. In proof of this, the pine lands of 
the Carolinas, Georgia, and Louisiana, which are elevated plains of 
sand, afford, during the summer and autumn, a healthy retreat from 
the diseases of the maritime and fluvial districts. Further; hilly 
and mountainous regions are not more remarkable, throughout the 
world, for their barren soil, than their salubrious atmosphere. Hence, 



Caldwell on Malaria. 307 

III contrasting the poverty, health, and hardihood of the Swiss, with 
the luxurious ease and effeminacy of the Italian, the poet expresses 
i himself in the following strain, whose sentiment is as correct, as its 
Miction is nervous. 

(( My soul turn from them, (the Italians) turn we to survey 
Where rougher climes a nobler race display, 
Where the bleak Swiss their stormy mansion tread, 
And force a churlish soil for scanty bread; 
No product here the barren hills afford, 
But man and steel, the soldier and his sword." 

Of all this the reason is plain. The soil of hills and mountains 
contains but a small portion of vegetable and animal remains in a 
dissolving condition. It is wanting, therefore, in one of the elements 
of febrile miasm. The issue is in conformity to a law of nature. 
The cause being absent, so is the effect. No malaria in the atmos- 
phere, no disease among the inhabitants. Such is the case, through- 
out the world. Withhold from any place heat, moisture, or vege- 
table and animal remains in a state of dissolution, and it will be 
exempt from miasm and bilious complaints. Unite them under the 
circumstances already indicated, and the reverse will be the conse- 
quence. Malaria will be generated, and disease will prevail. 

Am I asked whether large masses of animal matter alone, espe- 
cially the matter of the higher orders of animals, such as corpses in 
crowded cemeteries, and the carcasses of men and horses in besieged 
towns, and on the field of battle, ever produce bilious fever? To this 
question I can reply only as a reader of books, and a listener to re- 
ports; and those sources of information are self-contradictory; being, 
in some instances, affirmative, and in others negative. From per- 
sonal observation I know but little of the matter. If I am not mis- 
taken, I have seen yellow fever produced in a city, by putrid oysters, 
fish, and hides; the last of w r hich articles belong to a high class of 
animals. Whether the same result would be produced, on a field of 
battle, in the free and open air of the country, some may deem 
doubtful. Many reports, however, not unworthy of credit, are 
strong and positive in affirmation to that effect. Were I to hazard 
an opinion on the subject, it would be, that wherever found, large 
masses of animal matter, in high putrefaction, may generate a poison 
productive of fever. That such is the case in the semi-stagnant at- 
mospheres of cities, does not, I think, admit of a doubt. Had I 
leisure to dwell on the subject, it would be easy to show, that the 
immense exhumations of dead bodies in Dunkirk and Paris, with 



308 Caldwell on Malaria. 

other analogous facts related by Dr. Bancroft, furnish no evidence- 
subversive of this belief. But I am not persuaded that the poison is 
the same with that of common bilious fever. Facts seem to justify 
a contrary belief. The latter being chiefly of vegetable, and the 
former exclusively of animal origin, they can scarcely be identical. 
The diseases, moreover, which they produce, differ not a little in 
type and character. Fevers resulting from an animal miasm are 
more continued in their forms those from a vegetable one less so. 
Other evidences of a difference between the two miasms exist. But 
as the point is not essential to the present inquiry, I shall not dwelt 
on it. 

Different opinions are held respecting the influence of the exhala- 
tions from slaughter-houses, and from soap, candle, catgut, and glue 
factories, on the health of the neighbourhoods in which they stand. 
Most persons pronounce these effluvia deleterious! while a few have 
contended that they are not only innocent, but actually salutary. I 
am but little inclined to become the advocate of either opinion. That 
any exhalation from dead matter mingling with the atmosphere, is 
positively healthy, I do not believe. I am not sure that even the 
fragrance of incense or the perfume of flowers is so. On the contrary, 
I apprehend they are not. The freer the air is from every foreign 
mixture, the fitter it is for respiration, and the more subservient to 
the preservation of health. But while I admit that the exhalations 
under consideration do harm rather than good, I have no reason to 
believe that they produce yellow fever, or any other bilious affection. 
I have repeatedly examined the slaughter-houses, and the factories 
just designated, of some of our large cities, with a view to satisfy 
myself as to the influence of their effluvia. The odour they emit, 
though offensive, is not sickening. Nor is it the issue of that far- 
gone putrefaction, which, in the substances concerned, would seem 
necessary to the production of a febrile poison. Such putrefaction 
would render the articles subject to it unfit for use. They are 
therefore worked up, before they reach it in the changes they under- 
go. Nor is this all. There are yet stronger reasons for doubting 
the pestiferous qualities of the effluvia I am considering. Those 
persons most subject to their action are not injured by them. 
Butchers, and workmen in the factories mentioned, enjoy as good 
health as any of their fellow citizens. Be the cause what it may, 
the former are even proverbially healthy and robust. Nor is the 
health of the neighbourhoods immediately exposed to the exhalations, 
in any measure harmed by them. Throughout the year, it is no less 
perfect than that of other places. For these reasons, I cannot con- 



Caldwell on Malaria. 309 

cur with those, who denounce the places referred to as sources of 
malaria. 

The precise degree of moisture most favourable to the production 
of bilious miasm has been lately a theme of inquiry and discussion. 
And perhaps the question is not yet decided. An article on the sub- 
ject was published about ten years ago, by Dr. Ferguson, of the 
British military staff*, in Vol. IX. of the "Transactions of the Royal 
Society of Edinburgh," and republished, with commendations, in 
Vol. VII. of the " Philadelphia Journal of the Medical and Physical 
Sciences. " In that paper, which has attracted more attention than 
it deserves, the author professes to teach physicians something new, 
as respects the production of febrile malaria, more especially as 
relates to its connexion with vegetable and animal matter, and the 
amount of moisture requisite to the process. But as far as fact and 
useful information are concerned, he professes only. Actual per- 
formance, in any part of the effort, is looked for in vain. The only 
thing new contained in his article, consists in a few inferences and 
notions, which are manifestly erroneous. Many of his facts are in- 
deed individually new, because they had not been previously report- 
ed. But, in kind, they are as familiar to the enlightened portion ot 
the profession as any others connected with medicine. They tend 
to show that but a small proportion of water is requisite to the for- 
mation of bilious miasm, and that therefore marshy and flat alluvial 
situations, which are healthy in wet seasons, because they are flood- 
ed, are sickly in arid ones, because they are drier. Such, I say, is 
the only purport of his facts; and it was as well known to the fa- 
culty half a century ago as it is now. Almost every author of repu- 
tation that has written within that period on the connexion between 
bilious fever and the character of the weather, has recorded his tes- 
timony to that effect. Nor does daily observation withhold its con- 
currence. Those who live near mill ponds are perfectly aware, that 
in wet seasons, when the ponds are full, the neighbourhoods around 
them are much healthier, than in dry ones, when their waters are 
low, and a line of alluvial deposit along their edges is exposed to the 
sun. Respecting swamps, marshes, and rivers, the same is true. 

When flush in water during rainy seasons, they do no injury 
to the health of those who inhabit their vicinity. But when then- 
waters are deficient, in consequence of a drought, and their alluvion 
uncovered, they become sources of miasm, which produces disease. 

Such, I repeat, is the amount of all that Dr. Ferguson's facts are 
calculated to teach us, in case we had been ignorant of it. But it 

27* 



310 Caldwell on Malaria. 

is not all he professes to teach. If he has not expressed himself in a 
way to conceal or pervert his meaning, he wishes to establish the 
notion that bilious malaria may be generated without the agency of 
either water or vegetable and animal relics. Speaking on this sub- 
ject, he says, "as is the dryness of the soil, so is the quantum of 
sickness." In other words, the drier the soil is, the more miasm it 
produces. Render it therefore perfectly waterless, and you raise to 
its maximum its productive power. If this be not a correct inter- 
pretation of the doctor's expression, and a fair inference from it, the 
fault is not mine. He ought to have used a less equivocal form of 
diction. Again, says our author, "One only condition, then, seems 
to be indispensable to the production of marsh poison, on all surfaces 
capable of absorption, and that is the paucity of water, where it had 
previously abounded." If this sentence has any definite meaning, 
it is as follows. Wet sufficiently any surface capable of absorption, 
and suffer it to dry again, (in doing which you have in it a previous 
abundance, and a subsequent paucity of water,) and you will pro- 
duce bilious miasm by the process. Is this true ? No, certainly, 
every sophomore in medicine knows it is not. A bed of pure alu- 
raine, of calcareous or silicious earth, or even a pure but porous 
sand-stone constitutes a surface "capable of absorption." But the 
mere wetting and drying again of these will produce no malaria. 
The fancy is absurd. When thus presented in its nakedness, Dr. 
Ferguson will not himself advocate it. Mix vegetable and animal 
relics with those articles, and then wet the impure masses, and suffer 
them to dry again, exposed to a hot sun ; and, in the course of the pro- 
cess malaria may be generated. But to produce it by our author's 
process is impossible. Other parts of the doctor's paper are also at 
war with science. But being less relevant to the present inquiry, I 
shall not notice them. It may not, however, be amiss to observe, 
that an article of more merit, from an American pen, would have 
been less valued by a great body of American physicians. Our pro- 
fessional spirit is still colonial. It retains not a little even of the 
nursery. An offering of food from the "mother country," no mat- 
ter how indifferent its character and cooking, is prized above all that 
can be prepared at home. Although this is not true in every case, 
it is so to an extent that is humiliating. Thus the visions of Dr. 
Barry, about "venous circulation," became for a time, and perhaps 
still continue, the "paramount law," with many physicians of the 
United States. Yet never were fancies more unfounded. But to 
return. 



Caldwell on Malaria, 311 

3. What are the best means of preventing the formation and re- 
moving the sources of malaria? 

To this great practical question, on whose solution, and the mea- 
sures founded on it, depend the health and lives of millions, an an- 
swer may be rendered in a single word — cleanliness. Nothing further 
than the preservation of this can be done, nor is any further neces- 
sary, to " remove, (or destroy,) the sources of malaria," which will, 
of course "prevent its formation." All real filth consists in a mix- 
ture of two of the elements of bilious miasm; water, and vegetable 
and animal relics. It has been already shown, that without such 
mixture that poison cannot be formejl. The removal or destruction 
of the mixture constitutes cleanliness. By that process, then, I re- 
peat, and by that alone, can the production of bilious malaria be pre- 
vented. Over atmospherical heat in the warm climate of the 
United States we have no controul. It will visit us in the summer, 
and part of the autumn. Nor could we subsist without it. Our 
exemption, therefore, from the effects of the poison, can arise only 
from the adoption of proper measures, as to the other two elements 
of it. 

Am I asked in what way the requisite cleanliness can be preserv- 
ed? I reply that the process is different in different cases. Nor is 
it possible for me to treat the entire subject in detail, without ex- 
tending my dissertation to a volume. I can do nothing more than 
speak in general terms of the means of preserving cleanliness in a 
few instances. Nor is more requisite. The same principles are ap- 
plicable in every case. When fully understood, therefore, they can 
be employed universally, without further instruction. 

Man works wisely and successfully only when he imitates nature. 
As often as he opposes her, or deviates from her economy, he suffers 
disappointment; if not misfortune. Let him receive his lessons and 
procure his means of operation from her, and he will rarely fail to 
attain his ends. Her chief agents in producing and preserving 
cleanliness are four; pure water, pure air, fire, and active vegetation. 
Add to these, certain large voracious animals, and hosts of small 
ones, that feed on carrion, offal, and other sorts of filth, and the 
catalogue is sufficiently full for my purpose. She never employs, 
with this intention, smoke, suffocating fumes, or strong and offensive 
odours. Nor ought man to do it. By the judicious management of 
the agents just enumerated, he can do all that is required of him, in 
the removal and destruction of nuisances injurious to his health. 

Is personal cleanliness the object in view? By water, soap, and 
towels, it is easily compassed. And in the removal of the causes of 



312 Caldwell on Malaria. 

disease, and the general maintenance of health, it is a measure of 
much more importance than it is commonly supposed to be. I wish 
there were less ground to add, that it is too much neglected in the 
United States. 

Is a house or ship to be cleansed? Unite to the means just directed, 
brushes, sand, and free ventilation, and success, in most cases, is 
certain. Foulness beyond the reach of these can be subdued only by 
lire, which is competent to the purification of all things combustible. 
Smearing with lime, commonly called whitewashing, is but a slovenly 
substitute for real cleanliness. It conceals filth, but does not re- 
move it. It is indeed but the substitution of one evil for another; a 
less for a greater; but still an evil. Yet it is one of the best means, 
in cases where the employment of water is forbidden by causes that 
cannot be controlled. But it should never be used for the purifica- 
tion of any thing constructed of wood. Painting is a mode of cover- 
ing filth equally effectual, and more durable. In all wooden fabrics, 
therefore, it is entitled to a preference. Whitewashing is a common 
expedient for the purification of foul ships, in quarantine establish- 
ments. So is fumigation by the combustion of certain substances, 
some of them odorous, as well as by gases otherwise produced. The 
practice is in both cases empirical. I know that this sentiment is 
not considered orthodox. Legitimacy and fashion, which too far 
sway the world, are against it. No matter. It is not, on that ac- 
count, the less true. Orthodoxy is but opinion sanctioned by autho- 
rity; but, in the present case, there is no divine right to dictate. 
What is the avowed object of whitewashing and fumigating? To 
neutralize febrile miasm, real or imaginary. If no such miasm exist, 
the practice is superfluous, and the time and means spent in it are 
thrown away. If it does exist, what are its nature and affinities? 
No one knows. To pretend to neutralize it, therefore, without such 
knowledge, is palpable empiricism, not to call it imposture. It is as 
bad as the exhibition of a patent remedy to cure a disease, of whose 
seat and character the exhibitor is ignorant. The nostrum is as 
likely to destroy the patient, as to remove the complaint. The whole 
is haphazard and deception, and ought to be discountenanced by the 
friends of science. It checks rational inquiry, and retards improve- 
ment. Confidence in imaginary means is hostile to the discovery of 
real ones. It renders men content with the present, and improvi- 
dent as to the future. True, we see certificates from physicians, of 
the efficacy of fumigation, in cleansing foul and sickly ships and hos- 
pitals, and rendering them sweet and healthy. So do we of the in- 
fallibility of Swaim's panacea, in the cure of disease. And the tes- 



Caldwell on Malaria. 313 

timony is as valid in the one case as in the other. In both, it is an 
outrage on rational medicine. Combustion excepted, I repeat, that 
thorough washing and ventilation are the only certain means disco- 
vered, to purify foul and sickly ships, and render them the abodes of 
cleanliness and health. Of hospitals and infirmaries the same is true. 
In them also painting and whitewashing are the best substitutes for 
real purification. They are, however, only substitutes, and should 
never be adopted but in cases of necessity. And they should be pre- 
ceded by cleansing with soap and water, in every instance where no 
paramount reasons forbid it. As far as real purification is concerned, 
they are much more ornamental than useful. The cleanliness they 
produce is seeming rather than real. 

There is no edifice that may not be kept sufficiently pure by the 
means here indicated. It is not only useless then, it is injurious, to 
fill the wards of receptacles of the sick with suffocating and irritat- 
ing fumes and gases, to the annoyance and distress of patients with 
tender eyes and weak lungs. I have never seen a place thus fumi- 
gated, without exciting among the sick painful coughing and other 
disagreeable affections. And if disinfection seemed to be the result 
of the process, it was owing to the other means used at the same 
time, and not to fumigation.* 

Is a city to be depurated of the filth which threatens to produce a 
pestilential disease ? The work must be done by scavengers, carters* 
and watermen. The two former must remove the filth that lies in 
masses, and the latter must follow them and wash away the remains. 
Mere scraping and shovelling do but little good. They remove what 
is unsightly, and some of that which offends the smell, and there 
their action ceases, much of the nuisance still remaining. Water 



* Shall I be told, in objection to my opinion on this subject, that chlorine 
gas and some others destroy the fetid exhalation emitted by putrid animal mat- 
ter, and in that way contribute to purity? The fact is known to me, but it is 
also known that such exhalation is not the febrile miasm of which I am 
treating*. That poison exists in its most virulent and destructive condition, unac- 
companied by any odour. It does not follow, therefore, that because chlorine 
gas destroys the fetor arising from the dissolution of animal or vegetable suL 
stances, it will also destroy the poison. This loose substitute for reasoning is 
an abundant source of error and mischief. Nothing but an accurate and suc- 
cessful experiment is competent to prove that any known gas is capable 
of uniting with febrific malaria and neutralizing it. And as far as I have 
been able to inform myself, such an experiment has never yet been made. 
Hence the belief in the antimiasmatic properties of the gases referred to is no- 
thing but hypothesis. 



3 14 . Caldwell on Malaria. 

alone can carry that away. And, to be efficient* the washing must be 
executed with a degree of care and accuracy greatly beyond what is 
generally observed in it. It might as well be entirely neglected as per- 
formed in the usual slovenly manner. Forty-nine times out of fifty, 
filth enough is left in the streets and gutters of one city to infect and 
sicken a dozen. Hence our constant summer and autumnal com- 
plaints. The process of cleansing fails in preventing disease, not be- 
cause it is imperfect in its nature, but because it is imperfectly per- 
formed. Such indeed is the ground of most failures; faithless and de- 
fective execution, rather than unsound principle. Many more per- 
sons die from a partial observance or an actual violation of medical 
directions, than because the directions are erroneous or unwise. Even 
a bad system, judiciously administered, is a less evil than the wisest 
system mismanaged or neglected. To the truth of this, experience 
in every kind of government, whether public or private, abundantly 
testifies. Hence the lines of the poet may be received as a maxim: 

"For forms of government let fools contest, 
That which is best administered is best." 

Nor is this more obviously true, in any case, than in the cleansing of 
streets. If they be not thoroughly purified, they might as well be left 
untouched. Filth, thinly spread over a wide space, is much more de- 
leterious than when lying in a denser layer over a smaller space. 
This, with the reason of it, must be obvious to every enlightened 
physician. And as practised by scavengers, the cleaning, so mis- 
called, is but little else than a spreading process. It extends the limits 
of the nuisance which it is designed to remove, by drawing feculence 
from the gutters into the streets. If the filth, being half an inch deep 
be reduced to the twentieth of an inch, its power to injure is not les- 
sened. It is from its surface, on which the heat immediately acts, 
and not from any distance beneath it, that the miasm issues. I speak 
from oft-repeated observation in declaring, that I consider street 
cleaning, as usually performed, one of the most serious abuses com- 
mitted against the inhabitants of a city. It begets confidence only to 
betray, and promises health only to destroy it. To be convinced 
that I speak truly, it is only necessary to follow and examine atten- 
tively the track of a gang of scavengers when they are removing filth. 
They have evidently no correct knowledge of the purpose for which 
they are working; or if they have, they wantonly disregard it. In 
violation of their duty they leave much filth behind them, and thus 
endanger the public health. Unless this grievance be remedied, and 
real instead of pretended purification be practised, we shall look in 



Caldwell on Malaria, 315 

vain for any marked amendment in the health of our cities. Nothing 
but a thorough lustration will serve". True, compared with former 
times, the condition of cities, in point of cleanliness, is much im- 
proved. And the fact amounts to an argument that nothing can shake 
in favour of the position for which I am contending. Their health is 
improved in an equal ratio. Authentic records tell us, that when 
London and other large European cities were visited frequently by 
pestilential diseases, their streets, squares, and dwellings, as well as 
their environs, were filthy almost beyond conception. I hazard nothing 
in stating my belief, that there exists not on earth a single city, that 
may not, by a strict observance by its inhabitants of a judicious 
course of diet and regimen, and a degree of cleanliness perfectly 
practicable to an efficient police, be rendered a safe habitation to 
man, I mean throughout the year. To this neither Grand Cairo, 
Aleppo, New Orleans, Havanna, nor any other city in tropical Ame- 
rica constitutes an exception. But to attain an end in all respects so 
desirable, the police must be enlightened, faithful, and vigorous. It 
must be administered by officers who know what cleanliness is, how 
to appreciate it, how to produce and maintain it, and who will be vi- 
gilant and resolute in the performance of their duty. And this is a 
spectacle I have never yet witnessed. Never have I seen the health of 
a city under the guardianship of a police that seemed either to under- 
stand the true meaning of purity, or to be willing to encounter the 
labour and trouble necessary to enforce it. I say " enforce, 7 ' for un- 
less compelled to the observance of it, adults are as negligent of 
cleanliness on and around their premises, as children are; or as if 
they took delight in associating with filth. Nor does their careless- 
ness escape with impunity. To this negligence much of their suffer- 
ing from sickness is to be attributed. 

No large city can be effectually purified, except under an arrange- 
ment by which clean water can be made to flow actively along the 
gutters several hours every day. The degree of inclination of the 
streets, therefore, should be carefully suited to this purpose. Nor, 
during warm weather, should this mode of washing them ever be ne- 
glected. By means of it much filth will be carried off, which would 
otherwise remain, to discomfort the inhabitants, and injure their 
health, There is, moreover, in the view of cool, limpid, running 
water, something exceedingly pleasant to the eye, and exhilarating 
to the spirits; a condition of things much more favourable to health 
than offensive prospects, with dejection and gloom. It betokens 
purity; the very idea of which is valuable, and tends to produce the 
thing suggested. There is a much stronger and closer connexion be- 



316 Caldwell on Malaria. 

tween internal and external purity than is generally imagined. The 
one is the natural expression of the other; and they impart to each 
other mutual strength. 

Is the city checkered by vacant squares, public or private? Unless 
it be forbidden by insuperable causes, let them be enclosed with pali- 
sades, or some other kind of open work, sodded, or otherwise covered 
with grass, and suitably shaded and ornamented with shrubbery and 
trees. The addition of fountains and open reservoirs of water will 
greatly enhance their usefulness and beauty. Improvements of this 
description, when well regulated and turned to the proper account, 
are not places of mere pleasure and luxury; they are means of real 
comfort and sources of health. They are eminently useful as a re- 
sort of children, for air and exercise, under the care of their nurses 
and -attendants. Adults also may advantageously avail themselves 
of them, for the same purposes. Nor should their benign influence 
<on health, as places of amusement, social enjoyment, and pleasing 
contemplation, be overlooked. Considered in all their qualities 
and bearings, they constitute a rus in urbe peculiarly desirable. Ot 
the decorating of wide streets with rows of cleanly and beautiful 
trees, I am inclined to think favourably for similar reasons. 

Although, as heretofore mentioned, I know of no instance in which 
cemeteries, slaughter-houses, tan-yards, or factories of soap, glue, or 
candles have injured the public health, yet they ought not to be 
situated in central or thickly inhabited parts of cities. To say the 
least of them, they are unsightly and disagreeable establishments; 
and admitting that they do not send forth febrile miasms, they cer- 
tainly adulterate the atmosphere by their effluvia. It is alleged, 
moreover, and I apprehend not without cause, that cemeteries some- 
times contaminate the waters of adjacent wells. Prudence, therefore, 
concurs with a love of cleanliness, in admonishing that all such places 
be without the city. 

Much has been said and written to prove the bad effects of privies 
on the health of cities^— more, perhaps, than, within the last and the 
present century, is true. When those places were above ground, 
and openly exposed, as was the case in former times, their pernicious 
influence could not be doubted. But constructed under ground, as 
they now are, and securely covered, they can scarcely, I think, be 
considered injurious to health. But they must be kept clean. I mean 
that their contents must not be suffered to rise near to the surface of 
the earth. If they be kept five or six feet, or perhaps even a shorter 
distance below it, and are sufficiently covered by a well-construct- 
ed building, the temperature of the air in contact with them will be 






Caldwell on Malaria. 317 

too low for the production of miasm. The amount of liquid, more- 
over, which they usually contain, is too great for that effect. But if 
not properly constructed, privies are much more likely than burying- 
grounds to adulterate the wells that are near to them. To prevent 
this, they should be lined with stone or well-burnt bricks, cemented 
with water-lime. This will form an impervious barrier to the escape 
of their contents, and render them harmless.* As relates to this point, 
however, a general system of water-closets, such as that which exists 
in London, is preferable to every other mode of cleanliness. 

I know it is contended by many, that, whatever may be its accu- 
mulation or degree of exposure, human ordure cannot, under any 
circumstances, be converted into a source of febrile miasm. But I 
also know that the opinion is destitute of proof. All the facts ad- 
duced in support of it are necessarily of a negative character. Nor 
do they bear the slightest resemblance to negatives in grammar. No 
number of them that nature may present or industry collect, can ever 
make a positive. They therefore prove nothing. To establish pro- 
bability is the utmost they can effect. As relates to the present topic, 
in every negative case that can be adduced, circumstances inky have 
been wanting, which, had they been present, would have altered the 
result. But admit that human ordure alone cannot be rendered pro- 
ductive of malaria, the fact does not militate in the least against my 
position. It is well known that in cities, privies are made receptacles 
of other kinds of filth and feculence that may produce it. By ne- 
glecting them, therefore, health is endangered. 

Is the city commercial and situated on navigable water? Let not 
the wharves be built exclusively of wood. Their facing at least 

* To common-sewers, in cities, similar remarks are applicable. When skil- 
fully constructed they are not dangerous as sources of disease. Give them suffi- 
cient depth, width, and descent, line them with brick or stone and water-lime, 
and make no more openings into them than are necessary, and they will send 
forth no miasm to adulterate the air. Their depth and covering- will protect 
their contents from summer heat, and their width and descent will prevent stag- 
nation. Under these circumstances, putrefaction cannot take place in them. 
Nor, if it did, could the gas produced by it escape in any injurious amount, ex- 
cept by means of too many openings. Sewers thus prepared may be kept so 
clean by currents of water being made to pass through them, that they can 
create no sickness. Nor will they contaminate wells or fountains in their 
neighbourhood, by the percolation of their liquid contents. Let them be suffi- 
ciently numerous to convey from the city its foul waters, and other recremental 
matter, and they will contribute greatly to the preservation of health. They 
will act like drains in marshy ground, the benefits of which will be spoken of 
hereafter. 

No. XVI— August, 1831. 28 



318 Caldwell on Malaria, 

should consist of stone or brick, else they will become in time masses 
of dissolving vegetable matter, and abundant sources of febrile miasm. 
That the cities of the United States suffer in their health, from this 
cause, cannot be doubted. Piles of decaying timber, alternately wet 
and dry, and exposed to the ardour of an American summer sun, 
must produce malaria as certainly and naturally as the influence of 
spring promotes vegetation, and the rigours of winter suspends it. In 
places where the tide rises and falls six or eight feet, it is not uncom- 
mon for the docks to be so shallow, that the immense beds of filth 
they contain become bare, and are exposed, during low water, to the 
action of the sun. While in this condition, the exhalation from them is 
often intolerably noisome and sickening. The filth accumulated in 
them, moreover, is usually of the very worst character. It consists 
of the vilest feculence, washed from the streets, alleys, and other 
places still more foul, by rains and water from other sources. When 
exposed, therefore, and acted on by the sun, it were superfluous to 
say, that it constitutes a laboratory of malaria, as fertile and threat- 
ening as imagination can conceive. I could name a city that has 
suffered greatly from this cause. The docks should be so deep then, 
as to have their bottoms always covered with eighteen inches or two 
feet of water. Nothing short of this can protect the city from the 
nuisance referred to. Appealing so strongly and offensively as it does 
to our sight and smell, to say nothing of our reason and sense of 
danger, the neglect in relation to it is surprising. The importance 
of remedying the evil, where it exists, cannot be too frequently or 
forcibly impressed on the guardians of the public health. It is be- 
lieved that wooden wharves exposed to fresh water, are more per- 
nicious in their influence on health, than when the water is salt.* 
But they are pernicious in every case, and should be therefore 
exchanged for brick or stone. Although they are not individually 
so serious a nuisance as foul and shallow docks, they are oftener 
met with. Their excess in number, therefore, so far tends to make 
the balance even, that perhaps they constitute, in mass, as great an 
evil. 

* It is contended by some, on the authority of Sir John Pringle, that a small 
quantity of salt accelerates putrefaction, and that therefore timber and other 
vegetable matter wet with the water of seas and bays pass to dissolution more 
speedily than when wet with the water of rivers. This is a mistake. Salt 
never accelerates putrefaction, but always retards it. In its mode of effecting 1 
this, I take at present no concern. The fact is sufficient for my purpose; and 
that is certain. It is known to mariners that ships decay sooner in fresh water 
than in salt. 



Caldwell on Malaria. 319 

Tile and slate make a much better covering for city edifices than 
shingles. To say nothing of their greater durability, and the supe- 
rior protection they afford from fire, they are exempt from dissolu- 
tion, and do not contaminate the atmosphere around them, nor the 
rain that falls on them, to be afterwards received into cisterns for 
use. Of wooden coverings the reverse is true. Under the process 
of decay, they adulterate both air and water. Shall I be told that 
this is a very limited source of mischief? I know it; but it does mis- 
chief; and that justifies my reference to it. I do not call it great: 
but I say that masses are composed of molecules, and that it there- 
fore adds to the aggregate of the evil. The collective mischief done to 
us through life, by small evils, which we neglect because they are 
small, surpasses that we experience from larger ones. 

Is a fenny or marshy tract of country to be cleansed from the ma- 
terials productive of malaria? A process must be instituted, founded 
on the same principles, but different in form and mode of execution 
from those just described. The entire scene being dissimilar, the 
success of the attempt to cleanse must depend, as in all other in- 
stances, on its correct adaptation to the nature of the case. It is to 
consist in sufficient draining and banking, and the judicious cultiva- 
tion of the soil. The channels formed in the process, therefore, must 
have such an inclination, that the water they contain shall, flow freely. 
Marshes and fens must be thus converted into fields, meadows, and 
gardens; and places where filth lay exposed and reeking with poison, 
must be clothed in dense and vigorous vegetation. This mutation of 
surface moreover must be general. To make it only in parts is but 
little better than lost labour. A few neglected spots, although they 
are small, will baffle hope and frustrate expectation founded on the 
cultivation of many larger ones. By the process here directed, man 
subserves a two-fold interest. He accumulates riches, and secures 
health. That from which neglect would distil a poison, industry 
turns to gold; and the vegetation sustained by masses of pollution, 
renovates the atmosphere, and renders it healthful. For vegetables 
not only feed on air that is foul, but send forth an abundance of that 
which is pure. In the course of improvement it is often found neces- 
sary to narrow and deepen wide and shallow streams by artificial 
banks. This change not only confines the water within more cir- 
cumscribed limits; it accelerates its motion, and in that way contri- 
butes to the general effect. Other things being equal, the swifter the 
current of a stream, the less febrile miasm arises from it. To aid in 
forming that poison, water must stagnate. 

Am I called on for an example to prove, that the mode of cultiva- 



320 Caldwell on Malaria, 

tion here recommended, can give health to the inhabitants of a sicklv 
district? The summons is fair; and I answer it by pointing to what is 
called the Neck; a large body of land adjoining the city of Philadel- 
phia, on the south. Haifa century ago, that tract was but little bet- 
ter than a great morass. It was cultivated and inhabited only in 
spots. Nor did the Pontine marshes surpass it much in the extent 
and violence of its annual disease. It filled the Pennsylvania hospi- 
tal with dropsies and other sequelse of neglected or unskilfully 
treated bilious affections. But time and labour have converted it 
into meadows, fields, and gardens, rich in the products of the several 
kinds of cultivation pursued. It is grazed on, in parts, by herds of 
cattle, as fine as any the world exhibits. And the Philadelphia 
market receives from it an abundance of the choicest kinds of fruit 
and vegetable. Nor does it flourish more in vegetation than in health. 
Its population is now dense. "Every rood" of it maybe almost 
said to " maintain its man." And instead of the pallid cheek and 
languid movements, which characterized their predecessors, its pre- 
sent inhabitants exhibit as much of the sunburnt bloom, and vigorous 
limb, as belongs to the healthiest of their upland neighbours.* Add 
to this, that instead of being poor, as formerly, they are prosperous 
and comfortable. Such is the happy result of draining and banking, 
planting and sowing. In many other parts of our country that might 
be mentioned, the same process has uniformly led to a similar result. 
Nor can it fail to do so every where, until the laws of nature change. 
While filth shall continue a source of disease, and cleanliness .the 
reverse, so long may the inhabitants of any place do, what those of 
the Neck have already done — redeem health, and render fens and 
marshes more profitable than mines of gold or silver. 

Another very impressive instance of the happy effects of cultivation 
in reclaiming a swampy and sickly district to heaithfulness and 
prosperity, is derived from the history of Calcutta and the country 
around it. That city, built in a morass, on the banks of the Hoogly, 
was originally a speedy and almost certain grave to the Europeans 
who resorted to it for purposes of commerce. But a well-regulated 
police within, and the thorough cultivation of the environs without, 
have rendered it as healthy as any other city in a warm climate. 
The same is true of Barrackpore, Serampore, Chandernagore, and 
many other places in the province of Bengal. They were once 
sickly, but have been rendered healthy by means of cultivation, 
Bourdeaux furnishes another memorable example to the same effect 

* See American Intelligence for some remarks on this statement. ^-Ed» 



Caldwell on Malaria. 321 

When surrounded, as it once was, by marshes, it was one of the 
sickliest cities in France. Bilious fever prevailed in it as regularly, 
and almost as violently as it does in the vicinity of Rome at present. 
But the marshes became cultivated, and it and the country around it 
are healthy. 

In fine then, there is not on the shores of the Chesapeake, or the 
banks of the Mississippi, nor on any other shores or banks in the 
United States, a tract of fenny land, susceptible of redemption from 
the water by drains and levees, that may no be rendered inhabitable 
and healthy.* But to effect this, the cultivation, as already men- 
tioned, must be complete. Half done business, I repeat — and it can 
scarcely be too often repeated, is generally worse than neglect. It 
allures and encourages only to disappoint, and begets confidence only 
to betray. When the country around Edinburgh was in a half-cul- 
tivated condition, it was visited annually by intermittents and re- 
mittents, but in its present state of high cultivation, it is free from 
them. Of the country in the neighbourhood of London, the same is 
true. 

Is it required of me to present a picture the reverse of that exhi- 

* It is not contended that all places susceptible of draining" and cultivs 
can be rendered equally healthy. But they can be rendered places of com- 
fortable abode. The lowlands of the Carolinas, and I believe also of Georgia, 
are much healthier now than they were at the close of the revolutionary war. 
The cause is obvious. They are under higher cultivation. At the period re- 
ferred to, white men could not labour in them and retain their health. Negroes 
were therefore necessary. But they are less necessary now. In twenty or 
thirty years more, perhaps within a shorter period, they will not be necessary 
at all. White men will do their work to much more advantage. By that con- 
dition of things, the abolition of slavery in our country will be greatly facilitated. 
Like other evils, human bondage will disappear under the progress of improve- 
ment. But, in the present case, the event, however desirable, cannot be hur- 
ried without producing a worse evil. 

As relates to North Carolina, a fact has been ascertained, which proves the 
uncommon healthfulness of the state. By the last census it appears that the 
population of that commonwealth amounts to 738,470. Of this number of in- 
dividuals, 304 have attained the age of 100 years and upwards. This gives a 
centenarian in every 2425 persons throughout the state! What will Mr. Godwin 
and other Europeans who deny American longevity, say to this? Will- they 
persevere in proclaiming us a degenerate race? Can 304 centenarians be 
found in every 1,000,000 of the inhabitants of Great Britain and France? I do 
not possess facts sufficient to justify me in speaking positively on this point. 
But 1 doubt exceedingly whether the proportion of persons who attain to the 
age of 100 years, is half as great in either of those countries as in North 
Carolina. Yet that is not the healthiest state of the union, 

28* 



322 Caldwell on Malaria. 

bited in the case of the Philadelphia Neck, and the region in which 
Calcutta stands? I find it in the Pontine marshes. That spot was 
once the paradise of Italy — perhaps of the world. It was studded 
with resplendent villas, the summer residence of the wealth and 
fashion of Rome, and the chosen abode of health. Its halls were, 
therefore, crowded with blooming inhabitants from the city, and 
mirth and music resounded through its groves. May records, more- 
over, be credited, scarcely did its clustering roses exceed in fresh- 
ness its native daughters. But, mark the contrast. It is now, as 
its name imports, a waste of marshes, its palaces overthrown, and 
replaced by the huts of a few wretched peasants, whose only refuge 
from poverty and sickness is an early grave. The human voice is 
scarcely heard in it, except to moan. Such are the pictures, past 
and present, of that celebrated place. And to what cause is the con- 
trast to be ascribed? Difference in cultivation at the period referred 
to. When it was the abode o£ health, it was the abode also of industry 
and enterprise, which drained it of its waters, and clothed it in vege- 
tation, and thus prevented the formation of the seeds of disease. 
But indolence and neglect succeeded, and their kindred train of evils 
followed. The waters resumed their ancient places, ornamental 
and protecting vegetation perished, and in its place arose aquatic 
plants, to turn to dissolution, and aid in the production of febrile 
miasm, and disease again prevailed. Similar changes have occurred 
in the town and settlement of Fultah, on the banks of the Hoogly, 
below Calcutta. In consequence of a high state of cultivation, that 
place, rescued from a marsh, was once as healthy as aay in India. 
But through neglect, its original uncultivated condition has returned, 
and the jungle fever renders it now almost uninhabitable. A similar 
misfortune occurred to la ville neuve les avignon, which is situated 
on one of the branches of the Rhone. In former time, that town was 
celebrated alike for its healthfuiness and beauty. But the embank- 
ment of the river on which it stands giving way, its environs were 
Hooded and converted into a marsh. This event soon rendered it as 
remarkable for sickness as it had been previously for health. 

Such, in obedience to the eternal laws of cause and effect, are the 
changes in salubrity, which must always accompany similar changes 
in the cultivation of marshy tracts of country. Industry and tho- 
rough cultivation will be rewarded with health and plenty, while the 
lot of neglect and defective cultivation will be sickness and poverty. 
Allow the Philadelphia Neck to fall back under the dominion of 
water, w r eeds, and mud, and, like the Pontine marshes, it will be 
again under the dominion of bilious fever; and its inhabitants will, a 



Caldwell on Malaria, 323 

second time, suffer alike from disease and indigence. It is worthy 
of remark, that, in redeeming a marshy district from sickness, it 
should be put under a covering of vegetables that require but little 
irrigation* For this reason the rice plant is unsuitable; and a dense 
mat of meadow-grass is the best. Next to this are timothy, wheat, 
and rye. Clover is also admissible. 

The bad effects of an immature cultivation of the soil are further 
manifested in the succession of events that usually marks the settle- 
ment of new countries. The land being fertile is covered with a 
heavy growth of grass, underbush, and forest timber, which protect 
it from the sun. Under these circumstances no febrile malaria can 
be formed, because the surface of the earth, where the vegetable 
relics and moisture abound, is wanting in temperature. The settlers 
arrive, erect their cabins, and, for the first season, continue healthy. 
But this state of things cannot last. The earth is to be cultivated; 
and the cultivation must be at first immature. The axe and the 
mattock having removed the larger and smaller growth of timber, and 
the plough having furrowed the surface of the soil, the sunbeams get 
access to the moist vegetable mould; because as yet the crop of cul- 
tivated vegetables is not sufficiently dense to protect it. All the 
elements of malaria being thus brought together, the consequence is 
obvious. The poison is formed, and enters on its work. Hence, 
during the second summer and autumn of their residence in their 
new places of abode, the emigrants begin to suffer from the sickness 
called a seasoning. Nor does the evil immediately cease, inasmuch 
as the causes continue to operate, for a time, with a force but little 
diminished. At length, however, the condition of things changes. 
The cultivation of the soil being matured, its rawness and supera- 
bundant humidity disappear, and the growth of domestic vegetables 
becomes sufficiently close and heavy to protect the surface of the 
ground from the rays of the sun, and perhaps to appropriate to its 
own use the matter that would otherwise turn to miasm. For that 
matter becomes no doubt the food of the plants. The issue has been 
already told. The malaria of defective cultivation disappears with 
the state of things that produced it, and the primitive health fulness 
of the country is restored. If fens or marshes exist, they are drained 
and converted into meadows, which more completely secures the sa- 
lubrity of the place. In further illustration of the principles here 
maintained, it may be observed, that hurtleberry and cypress swamps, 
with all fens and marshes deeply shaded, never produce malaria. 
Why? Possibly for two reasons. They contain too much water; 
and the protection of their surfaces from the rays of the sun renders 



324 Caldwell on Malaria. 

them too cool for the process. Admit the sunbeams by the removal 
of their leafy covering, and miasm will be formed. 

Mill-ponds are often a fruitful source of malaria, Can any alter- 
ation be made in the mode of forming them, calculated to lessen or 
prevent the evil? I think there can. 

The amount of mischief done by a mill-pond, other things being 
alike, is in proportion to the quantity of vegetable matter, which it 
subjects to dissolution; and that again is usually determined by the 
extent of land that is flooded by the obstructed water. Two 
measures, therefore, present themselves for diminishing the evil; 
and either or both may be adopted, according to circumstances. In 
all cases the forest timber and underbush, covering the ground to be 
overflowed, may be cut down, grubbed up, and burnt, or otherwise 
removed, before the erection of the dam. Under this regulation 
much less vegetable matter will be dissolved. And in many in- 
stances, the construction of a levee or artificial bank, of a moderate 
height and extent, will confine the stagnant water within narrow 
limits; and thus will only a small portion of land be flooded. That 
these measures would prove useful, cannot be doubted. The erec- 
tion of levees would even add to the efficiency of the establishment, 
by giving a better head of water, than could be had without them. 
Nor do I perceive that any objection to them can be reasonably 
•urged. The expense attending them would rarely be very heavy. 
And if, in some cases, it should be so, what is the pecuniary interest 
of a few individuals, when balanced against the health and lives of 
thousands? That the removal of the timber and underbush from the 
flooded ground would be salutary, is proved by the fact, that old 
mill-ponds are much less deleterious than new ones. The reason is 
plain. From the former, vegetable matter is removed by decay. In 
the latter, it abounds; and while undergoing dissolution, produces 
malaria. To the precautions here suggested, add the planting of 
rows of shrubbery and trees along the levees or edges of mill-ponds, 
the benefits of which will be again referred to, and it is believed that 
the evils of those establishments will be greatly diminished. They 
will be rendered not only innocent, but ornamental. They will re- 
semble the willow-fringed lakes and fish-ponds of European parks, 
and pleasure grounds, and be no longer dreaded as laboratories of 
poison. 

4. When malaria is already formed, how may its effects on the hu- 
man constitution be most certainly obviated ? In other words, what 
are the means by which the inhabitants of a city, or a district of coun- 
try, subject to bilious fever, may best preserve their health? 



Caldwell on Malaria. 325 

Are these questions proposed to an honest and enlightened phy- 
sician, by those who have confided to him the care of their health ? 
He can render to them, in conscience, but one answer, «« withdraw 
from the sickly region, during the sickly season. Nothing short of 
this will certainly protect you." But the few only can follow the ad- 
vice. The many being destitute of the means of removal, or prevent- 
ed from it by indispensable business, must abide the evil. To these, 
therefore, the following remarks may perhaps communicate some use- 
ful information. 

It is a maxim in pathology, that during the prevalence, whether 
endemic, or epidemic, of a bilious fever, every inhabitant of the 
sickly district is predisposed to the disease. Nothing but an ex- 
citing cause is necessary to its production. Let such excitement, 
therefore, be strictly avoided, Am I asked what I mean by exciting 
causes? I reply, every thing that can produce fatigue, or any kind 
of exhaustion; every impression out of harmony with the system. In 
other and plainer words, improper exposure, intemperance, and all 
sorts of excess. Some of the most powerful exciting causes are, 
fatigue from severe or protracted exercise, or long endurance of in- 
ordinate heat, sudden and great vicissitudes in the atmosphere, es- 
pecially from a higher to a lower temperature, and from dryness to 
moisture, unguarded exposure to a current of cool air> a shower of 
cold rain, the evening dews or the common humidity of the night 
air, more particularly if the person be exposed in a posture of rest, 
in which case, should he fall asleep, the evil is increased; stunning 
and weakening injuries from blows or falls, inordinate indulgence in 
love, the influence of the other passions generally, more especially 
the passion of fear, and the action of intense and long-continued 
study. To these add excess in eating, drinking, and watching, the 
use of crude and indigestible food at any time, but particularly just 
before retiring to rest, deep anxiety or dejection of mind, and the 
swallowing of irritating and nauseous pills and potions, as preserva- 
tives of health. Such, I say, are some of the most dangerous ex- 
citing causes, which should be studiously avoided by all who are 
anxious to escape disease. But these are only passive duties of 
prevention. There are also active ones to be performed. 

If individuals escape a prevailing epidemic, next to their avoidance 
of exciting causes, they owe their safety to the prophylactic power 
inherent in their constitutions; that power denominated by the schools 
vis conservatrix naturae, whose province is to resist the influence 
of deleterious agents, and preserve health. Nor is this conservative 
attribute, as many have pronounced it, a creation of fancy. It as 



326 Caldwell on Malaria. 

certainly belongs to the human system, as the power to breathe, to- 
secrete bile, or to digest food. If it did not, health could not be 
maintained a single hour by individuals living, breathing, and swal- 
lowing in the midst of a virulent atmospherical poison. On this point 
I am anxious to be clearly understood. By the vis conservatrix na- 
turae I do not mean any separate and peculiar entity or principle at- 
tached to the constitution as a guardian of health. I do not identify 
it with the anima medica of Stahl. That would be a hypothesis too 
fanciful for the sober sense and practical views of the present age. 
I mean only a given and peculiar mode of action of the general 
powers of the system, or rather of its organs possessing power adapt- 
ed to its existing exigency. As are the exigency and demand of the 
system for the time being, so is the mode of action. Is food to be 
digested? The brain and all the other leading organs combine to aid 
the stomach in its work. To prove this would be easy, were it ad- 
missible in me to dwell on it. If those organs are feeble or diseas- 
ed, and unable to furnish aid, the work is not suitably performed, 
the stomach alone not being competent to it Is matter to be secret- 
ed to produce the reunion of a broken bone ? The general system 
must aid the part immediately affected, and especially destined to 
the work of secretion, or the process will fail. Hence, under the ex- 
istence of constitutional disease or debility, a broken bone does not 
reunite; at least it does so, if at all, slowly and defectively. Does 
any other form of disease exist ? The powers of the system must 
concur to remove it, or it will not be removed. Medicinal substances, 
unaided by those powers, cannot cure it. To enlightened physicians 
this is but a truism. They know that medicines are literally but the 
handmaids of nature. In like manner, when the system is assailed 
by febrile miasm, its powers must confederate to resist the poison, 
or disease will ensue, as certainly as ponderous bodies, when unsup- 
ported, fall to the ground, and those that are lighter than the atmo- 
sphere pass upward. And this confederacy is what I understand by 
the phrase vis conservatrix naturae. The philosophy of all this I 
w r aive, the fact alone being sufficient for my purpose. I do not know 
that this explanation is necessary on the present occasion. I trust, 
however, it will not be deemed irrelevant or improper. My chief 
reason for offering it is, that, when speaking on the subject, I have 
been often misunderstood; and I am solicitous that this should not be 
the case now. On this topic I shall only add, that, were it not for 
the attribute of which I have spoken, no exciting cause would be re* 
quisite for the production of bilious fever. The poison alone woula 
be competent to the effect. 



Caldwell on Malaria. 327 

Man escapes then, I say, from the influence of bilious malaria, 
when he does escape, in consequence of the resistance of his conser- 
vative power. And, other things being equal, the more perfect his 
health is, the more successful will be the resistance. This may be 
considered another axiom in pathology, whose applicability to the 
subject in question is plain, as will appear presently. 

Different, and even opposite opinions are entertained, and corres- 
ponding directions given, with regard to the kind of diet and drink 
most suitable to individuals, as relates to their protection during the 
prevalence of a bilious epidemic. Some physicians advise the entire 
abandonment of animal food and stimulating liquors, and the substi- 
tution of vegetable aliment and water in their place. This, we are 
told, is to purify the blood, and render it insusceptible of the febrile 
poison. Others pronounce this course too debilitating, and therefore 
calculated to invite disease. Accordingly their directions are, to 
eat more animal food, accompanied by more stimulating condiments 
than usual, and to drink more freely of vinous and spirituous liquors, 
in order to escape the sickness, by " living above it." 

I apprehend both sets of directions are equally wrong. Sudden and 
great changes of diet and drink are hazardous at all times, and under 
all circumstances. But they are peculiarly so during the prevalence 
of disease, when the constitution requires all its stability and firm- 
ness to enable it to resist the febrile miasm. But an immediate and 
striking change in food and drink necessarily deranges the constitu- 
tion, unsettles its economy, and weakens its powers. It requires of 
it a new order and degree of action, to accommodate itself to its new 
condition. It alters, moreover, its susceptibilities. In conforming 
to this new state of things, the constitution must abandon the old; 
and, in its transition from the one to the other, it cannot fail to be 
temporarily enfeebled. In the mean time, the malaria, plying its 
powers, gains an ascendency, and disease is produced. The condi- 
tion of the human system, when in this transition state, resembles 
that of an army engaged in action, whose battle array an unskilful 
commander imprudently changes in the face of an enemy, who, 
taking advantage of it, makes victory sure; or it may be likened to 
the condition of a ship in a gale. Her storm-stay-sails are set, and 
her helm lashed fast, and she is riding out the blast in safety. But 
the wind suddenly shifts, and renders another state of preparation 
necessary. Her present array, therefore, is broken up, that the other 
may be formed, and she is thrown loose, for the time, into the wind. 
The peril is great, and the issue often fatal. Before the new ar- 



32S Caldwell on Malaria, 

rangement can be completed, the vessel may be overwhelmed and 
the crew lost. 

I do not think it safe for those exposed to it to make any material 
change in their mode of living, during the prevalence of a bilious 
epidemic; I mean, provided they have lived temperately. For the 
intemperate I have no other advice but to return to sobriety, at every 
hazard. Better to die in temperance, than live in debauchery. Let 
the temperate, I say, adhere to that mode, which they have found, 
by experience to be most subservient to perfect health, and that will 
give them the greatest security against the influence of malaria. It 
will impart to their preservative power the greatest degree of vigour. 
Have they lived on vegetable food and water, and have these articles 
proved most salutary to them? Let them adhere to them. Has their 
food been animal, and their drink fermented or distilled liquors; and 
have these given them the highest health they have enjoyed? It would 
be indiscreet to change them. Nor, under the same proviso, ought 
they to make any alteration in diet and drink of a middle character, 
more stimulating than the former, and less so than the latter. The 
end aimed at is entire health, and whatever kind best secures that 
should be steadily persevered in. This, if I mistake not, is the dic- 
tate of common sense and experience; while the directions to change, 
as just specified, are the offspring of hypothesis. They are predicted 
on the assumption, that their authors know what state of the blood 
gives a liability to disease, and what a security from it; whereas, in 
fact, they know nothing of the matter. They do not even know 
that any /me state of the blood, independently of the condition of the 
solids, is preferable to another, as relates to the liability of the sys- 
tem to be injured by malaria. Nor have they the least knowledge 
how that fluid is affected by different kinds of aliment and drink. 
The whole is conjecture. But we do know that the more perfect the 
health is, the more vigorous is the resistance of the system, when 
assailed by any deleterious agent, and the less, of course, its liability 
to be injured by it. Should any slight alteration, however, in diet 
and drink be made, let the change be to articles that are lighter and 
less stimulating, rather than to those that are heavier and more so. 
In an especial manner, let heavy and stimulating food and drink be 
abstained from, during a state of exhaustion from excessive exercise, 
or long exposure to intense heat. In such a case, every thing taken 
should be cooling, light, and easy of digestion. The system calls for 
quietude, that it may recruit itself,' not for irritation by diet and 
drink, to exhaust it still further and more injuriously. 



Caldwell on Malaria. 329 

Clothing and exercise, judiciously regulated, are of great value, as 
safeguards from disease. The former should be such as may best 
maintain the healthy action of the skin, and protect it against sudden 
vicissitudes in the atmosphere. Let flannel or muslin, therefore, 
more especially the former, be worn next to it in preference to linen. 
The action of this kind of clothing is much aided, and its beneficial 
effects promoted, by perfect cleanliness of the skin, and the frequent 
use of the flesh-brush, or by frictions with a coarse dry towel, or a 
roll of flannel. The feet, in particular, should be carefully guarded 
against cold and moisture, which is also best done by woollen or cot- 
ton. The other articles of dress ought to conform to these. The 
end aimed at is to keep the body in an equable and comfortable tem- 
perature. Let the warmth preserved, however, be above the pimc- 
tum jucundum, or point of pleasant feeling, rather than below it. 
Woollen clothing generally, therefore, accommodated in its texture 
to the character of the weather, should receive a preference. 

Exercise should never be turned into labour. It should not, I 
mean, be so violent or long-continued, as to induce fatigue. The in- 
tention of it is to invigorate and strengthen, not to exhaust and en- 
feeble. When it is judiciously accommodated to this end, health is 
confirmed by it. It should be taken daily, in the open air, when the 
weather is favourable, and, if practicable, without the sphere of the 
malaria. Walking and riding on horseback are greatly preferable to 
" airings" in a carriage. The latter are well named. They are 
mere airings and nothing more. They do not amount to exercise, 
except for invalids, who can sustain no other sort of gestation. Sit- 
ting or lolling in a carriage is, at best, but a sedentary occupation. 
Exercise should be taken in the cool, but not the humid portions of 
the day. During the heat of the day it may prove dangerous, and 
should, if practicable, be avoided. Nor ought it to be indulged in im- 
mediately after eating, especially after dinner. Exercise, when the 
stomach is loaded with food, is never salutary. Nature herself ad- 
monishes of this. Hence the drowsiness and indisposition to motion 
felt, soon after meals, both by man and the inferior animals. The 
dog lies down to sleep, and the ox to ruminate; and man, if he has 
leisure, retires to his siesta. 

Does bilious or yellow fever prevail in a city? There are yet other 
precautions which have been found useful as means of prevention. 
Respecting the malaria of those complaints, two important truths are 
known. It does not rise to the highest stories of lofty city dwellings; 
at least it does not reach them in a state of full concentration, and 
strength; and exposure to it at night, especially during the inaction 

No. XVI.— August, 1831. 29 



330 Caldwell on Malaria. 

of sleep, is much more dangerous than exposure during the day. On 
these two facts, valuable measures of safety may be founded. 

Are individuals compelled, by business or duty, to pass the day 
within the sphere of the miasm? Let them, if practicable, sleep with- 
out it, ajrnight, and they may escape mischief. Or if unable to avail 
themselves of this precaution, let them adopt the next best, which is 
to pass the night in the upper stories of their houses, above the reach 
of the enemy. Let them indeed spend all the time they can in those 
stories, and they may be safe. This is no hypothesis. The practice 
recommended has been successfully tried. It is founded on princi- 
ple, and, if generally adopted, cannot fail to do good 5 although it 
may not, and I presume will not, protect from disease in every in- 
stance. When Europeans, in the cities of the east, retire to their 
domestic quarantine to escape pestilence, they confine themselves 
strictly to the higher floors of their houses. Their real intention in 
this, is to maintain a position as remote as possible from such per- 
sons, affected with plague, as may pass along the streets. Thus, in 
their opinion, they escape contagion. But they act wisely from mis- 
taken motives. There is no contagion in the case. Plague is no 
more contagious than yellow fever. Escape is to be accounted for 
on a different ground. The malaria of plague does not rise to a great 
height in the atmosphere. . Europeans, therefore, confined to the 
upper stories of their houses, are above the reach of it. Those who 
reside on the lower floors, however strictly they may seclude them- 
selves, do not so generally retain their health. 

The same miasm which produces common bilious and yellow fever, 
produces also cholera infantum, a complaint which prevails most in 
our large cities, and might there be denominated pestis infantum. It 
is known that the best and only certain means to protect infants from 
this disease, is to allow them to pass the summer , in the country. 
But there are not many cases in which this is convenient. In lieu of 
it, therefore, if the subjects to be protected cannot be allowed to 
sleep in the country every night, during the summer months, which 
would be the second best plan of security, let them enjoy the third, 
which is to pass their nights in upper stories. Let them pass the day 
there also, except during the hours of exercise in the open air, when 
they ought, if possible, to be removed without the limits of the malaria. 
A few hours every day spent in the pure air of the country, would 
aid much in maintaining the vigour of their systems, and in protect- 
ing them from disease. Again, it is known to every one who has at- 
tended to the subject, that, in districts of country where bilious fever 
occurs as an annual endemic, other things being alike, those who sleerj 



Caldwell on Malaria, 331 

m upper stories are less liable to the disease than those who pass their 
nights below. Nor is this all. In the places of which I am speak- 
ing the inhabitants find no inconsiderable security from the endemic, 
by erecting their houses on artificial mounds thrown up for the pur- 
pose. This practice is pursued in some of the sickly portions of the 
United States. And were the mounds made higher than they usually 
are, the security derived from them would be greater. True, the 
professed object of the inhabitants, in thus elevating their buildings, 
is to raise them above the common humidity of the soil, and in part 
above the ascent of the dew. But they aim at one end that is good, 
and attain another that is better. They live, and especially sleep, 
above the flight of malaria; and hence chiefly their safety arises. To 
escape from the dew, and other forms of moisture, is advantageous: 
but to keep out of the reach of the miasm is much more so. The 
former is but an exciting cause, and can do comparatively but little 
mischief, unless the latter has invaded the system, and produced a 
predisposition to disease. 

There are yet other precautions which may be advantageously 
practised by the inhabitants of places where bilious fevers prevail. 
They are especially applicable to sickly situations in the country. 
It is hazardous to go out in the morning with the stomach empty. 
Regular breakfast, or some gently stimulating and cordial beverage, 
accompanied by a cracker or a bit of bread, should be first taken. 
For the purpose in view, nothing perhaps is better than a cup of 
coffee, chamomile tea, or some other mild aromatic bitter. In the 
aguish counties of England, a glass of table beer, with perhaps some 
bread, is the usual substitute, and is no doubt a good one. In other 
places cider is used, it is said with beneficial effects. But wine and 
distilled liquors should be avoided. They are too stimulating for the 
end desired, and very often lead to intemperance. One of the most 
injurious and offensive practices in our country, and which brings 
down on us deservedly the reproach of foreigners, is that of morn- 
ing dram-drinking. Nor does it afford protection from malaria. 
Nothing we swallow can do that, unless it gives real strength pri- 
marily to the stomach, and by sympathy to the conservative power of 
the system. But such are not the effects of morning drams. They 
rouse the stomach to preternatural action for a time, only to sink it 
the deeper in exhaustion. It is a disquieting sense of this that leads 
to a repetition of them, until intemperance is the result. 

Is any one inclined to ask me, would not bread and cheese with a 
draught of water, or a breakfast of bread and milk, protect from 
malaria as well as coffee, beer, or cider? To this question I am not 



332 Caldwell on Malaria. 

prepared to answer in the negative. Perhaps an affirmative reply 
would be nearer the truth. But the experiment alone can answer 
definitely. And I know of no instance where it has been decisively 
made. For many years before his death, the late Dr. Tilton, of 
Delaware, breakfasted on the product of his own ground. If I mis- 
take not, the meal consisted chiefly of fruit, bread, and milk. Yet 
he enjoyed perfect health, and attained a very advanced age. On this 
topic I shall only add, that were our "temperance societies" to de- 
nounce excess in eating as well as in drinking, marking with equal 
disapprobation the use of improper food, and setting correct exam- 
ples themselves in relation to the whole, the prospect of a thorough 
reform would be much brighter than it is. A very frequent cause of 
intemperate drinking is intemperate eating, connected with the use 
of indigestible aliment. And for every drunkard in our country, we 
have a hundred gluttons, if, by that term, we mean those who eat too 
much. Nine hundred and ninety-nine out of every thousand per- 
sons in the United States eat to excess, and suffer by the practice- 
Like other matters floating in the atmosphere, malaria travels with 
the wind. It therefore does mischief, on the leeward side at a much 
greater distance from its source, than on the windward. Suppose it 
indispensable that a dwelling, fortress, or town be built near to a 
marsh that cannot be immediately drained and cultivated, and that 
the prevailing summer and autumnal wind of the place is from the 
south-west. Let the buildings be erected on the same side. Why? 
Because the wind will carry the malaria from them, and their inha- 
bitants will be healthy 5 while it will convey it directly to them, if 
they occupy the north-east side, and they will suffer from sickness. 
Hence the well-known fact, that in the southern section of the United 
States, where the prevailing winds of summer and autumn are 
from the south and west, the dwellers on those sides of marshes, 
swamps, rivers, and mill-ponds, are often in the enjoyment of good 
health, while the people on the opposite sides, although further per- 
haps from the laboratory of the poison, are victims to fever. 

Another precaution by which a town or single dwelling may be 
protected from the malaria of an adjacent marsh, is the interposition 
of a cordon of trees and underbush. If a growth of such timber, 
therefore, be already standing between the marsh and the buildings* 
let it remain | and if it be wanting, plant it. Trees of moderate ele- 
vation, with bushy tops, and which throw out limbs and foliage along 
their trunks, are best suited to form the barrier required. Many 
places in tropical climates have been rendered uninhabitable by the 
felling of trees and the destruction of underbush between them am. 



Caldwell on Malaria. 333 

neighbouring swamps and marshes; and their salubrity has been re- 
stored by the regeneration of the timber. In the United States simi- 
lar events have occurred. The evidence on the subject is therefore 
complete. This mode of obstructing the march, and obviating the 
mischief of malaria, has been practised time immemorial in Persia 
and other oriental nations. 

Would a lofty wall arrest the progress of malaria, issuing from a 
neighbouring source? I doubt not it would. Facts seemingly to that 
effect exist. The plague of Moscow found its way in but few, if any 
instances, within the walls of the Kremlin. I think, but cannot, on 
this subject, speak confidently, that the prisoners in the Philadelphia 
jail remained healthy, during the prevalence of yellow fever in that 
city, in 1798. Yet the disease, during that season, spread in all di- 
rections around the prison, where any inhabitants remained. 

The uninterrupted health of the inmates of monasteries and nun- 
neries, enclosed by walls, during the devastations of pestilence 
around them, is almost proverbial. It has been ascribed to different 
causes; strict temperance in diet and drink; general regularity of 
habit; exemption from strong and irritating passions; and a life of 
seclusion, leading to an avoidance of contagion from the sick. That 
the three former of these causes acted as means of protection from 
disease, cannot be doubted. But that the latter did not is equally 
certain, inasmuch as there was no contagion in the case. Others 
have regarded the escape of the meek recluses from pestilence, as a 
special blessing from above, on account of their piety. Persuaded 
that Heaven always stays natural calamities by natural means, I can- 
not abandon the belief, that the surrounding walls, which shut in 
those devout ascetics from the world, shut out malaria from them, 
and thus contributed to their safety. That those peaceful retreats of 
devotion may be the more secluded, the walls enclosing them are 
usually lined with rows of trees, and sometimes of shrubbery. These 
have therefore added strength to the protecting barrier. I have no 
hesitation in believing, that a rampart thus composed, provided the 
wall be lofty enough, and the rows of trees sufficiently dense; and 
provided also that the entrances be kept closed, will arrest completely 
the progress of malaria, and afford protection to the residents within. 

A knowledge of the exact distance from its source, to which ma- 
laria can travel, may aid much in the selection of secure situations 
for residence. But that knowledge is not know possessed by any 
one; nor does it seem to be attainable in the present state of science. 
Well-established facts seem to render it certain that, under different 
circumstances, the poison travels different distances. It has been 

29* 



334 Caldwell on Malaria. 

already observed that it moves further from its source with the wind 
than against it. And it may be added, that it travels further with a 
current of air, than through the calm atmosphere. Is the country 
level? The poison fills a wider sphere than if it were bounded by 
hills. For although it can attain the summit of a hill of considerable 
elevation, it is weakened by the journey, and rarely does much mis- 
chief on the opposite side. The distance it can pass along water is 
very limited. As already mentioned, it never reaches a ship lying 
cable's length from the shore. This has been satisfactorily ascer- 
tained in innumerable instances. During the prevalence of yellow 
fever in Philadelphia, families have taken refuge in vessels, anchored 
in the ship-channel, not more than from two hundred and fifty to 
three hundred paces from the wharves, and escaped disease. I 
doubt whether marsh miasm has ever passed over a river the fifth 
part of a mile in width. Unquestionably the inhabitants along one 
bank of such a stream are often healthy, while those on the other are 
suffering from bilious fever. Of a river not more than a hundred 
paces wide, I have known the same to be true. Families residing 
immediately on the leeward brink of such a stream are often healthy 
during the summer and autumn, while those on the same side, but a 
few hundred paces distant from the water suffer from bilious fever. 
The reason of this is plain. The wind cannot convey the poison 
across the river, to the former, while it removes from them that pro- 
duced on the same side, and carries it to the latter. Nor is this all. 
Between the margin of the stream and the families living a short dis- 
tance from it, there usually exists an interval of low ground, which 
is itself a laboratory of febrile malaria. This is also borne by the 
wind from the inhabitants resident on the water's edge, and thrown 
on those a little remote from it. Bilious miasm is said, by some 
writers, to travel from one to three miles, and by others as many 
leagues, from its source, and produce disease. The assertion wants 
proof. No authentic facts can be adduced in support of it. I have 
never known an instance, in which malaria, even when most abun- 
dant, produced fever more than half a mile from its source, perhaps 
not so much. I say, "when most abundant;" and certainly its 
amount must affect materially the distance it may reach. A large 
volume of it must be more diffusive than a small one, for the same 
reason that a gallon of wine, mixed with water, will give taste and 
flavour to a greater quantity of that fluid than a gill. In cases where 
malaria is believed to travel so far, intermediate sources of it are 
overlooked. I have already stated, and now repeat, that wherever 
there exists a bed of alluvial soil, or fertile soil of any kind, there the 



Caldwell on Malaria. 333 

poison may be generated. And, in those instances, where it is sup- 
posed to travel so far, if a competent examination be made, such beds 
will be found between the most striking source of it, erroneously 
considered the only source in the case, and the extreme point to 
which it extends. It is exceedingly doubtful whether any wind can 
carry malaria a mile from its source, in a state of such concentration 
as to produce disease. 

As relates to the means of ascertaining something of the mode and 
distance of the march of bilious malaria, the following facts may not, 
perhaps, be without value. Many years ago the late Professor 
Wistar removed annually with his family to a summer residence, 
about half a mile, or perhaps a little more, in an eastern direction 
from the Schuylkill. Compared with the bed of the river, the ground 
he occupied was lofty. But several ravines of considerable depth 
ran from the edge of the stream toward his dwelling. None of them, 
however, reached it. Some of his neighbours, especially those be- 
tween him and the river, were subject to intermitting fever. There 
was reason to believe, that the malaria productive of the disease came 
from the Schuylkill. While investigating the subject, the professor 
discovered that the morning fogs, which arose from the river, without 
reaching the summit of the heights on either side, travelled along the 
ravines to their termination, and then spread to given distances along 
the plain, in the neighbourhood of their mouths. This leading to 
further inquiry, his next discovery was, that the sickness which pre- 
vailed was confined almost entirely to the range of the fog. Those 
living without it were healthy, those within more or less diseased, 
Here, then, it would seem that the limits of the malaria and the fog 
were the same, and that the latter being visible, indicated the extent 
of the diffusion of the former. On the banks of the Ohio the same is 
said to be true. Is it not probable, then, that, as a general rule, 
habitual fogs from marshy ground may serve as a "cloud by day," 
to designate the places where human habitations maybe safely erect- 
ed? Let them be kept without the range of the visible exhalation*, 
and they will be more likely to be without that of the invisible. Where 
it is practicable to avoid it, dwellings ought not to be erected on al- 
luvial ground, especially modern alluvion. Such a situation may in 
time be rendered healthy, but not without much labour and skill, ac- 
companied probably by no little suffering. When it is possible to 
avoid it, an alluvial situation should never be selected for the encamp- 
ment of an army. Such a place has often produced sickness in a 
single night. 

It was observed, in a former part of this dissertation, that, in a 



336 Caldwell on Malaria. 

district subject to bilious fever, night exposure is particularly hazard- 
ous. Is it equally so at all times of the night? I apprehend it is not. 
It is most dangerous during the descent of the dew$ an event which 
occurs twice in the nights once soon after sunset, and again a little be- 
fore daybreak. The hours at which this meteor falls, in different lati- 
tudes, and under different temperatures, are not the same. Obser- 
vation alone can ascertain them, and enable those concerned to regu- 
late their movements accordingly. Their safety consists in avoiding 
exposure during the fall of the dew. If their duty, therefore, calls 
them out at night, let them select the period between the times of the 
descent of that meteor. Another precaution of great moment is, to 
continue in action while in the humid atmosphere. Exposure at night, 
in a state of quietude, more especially in a sitting or lying posture, 
is full of peril, and should be strictly avoided. To fall asleep during 
the time is still worse. 

Is any one wind more deleterious than another? I mean, is it more 
heavily charged with pestilential miasm? No; not in the abstract, 
and generally. If it is so, in any particular case, it is attributable to 
local causes. Much error, not to call it superstition, prevails on this 
subject, both in the minds of living physicians, and the writings of 
dead ones. The medical and poetic writers of Greece and Rome 
have said so much about the humidus and pestifer auster, that it 
almost makes a part of our professional creed, that the south wind 
is necessarily moist and pestilential. But nothing can be more des- 
titute of truth. The sirocco, which blights and kills from a lack of 
moisture, but has no pestilential taint in it, comes as frequently from 
the south as from any other quarter. And, in many places, the south 
wind is peculiarly salubrious. Instead of being always, moreover, 
surcharged with humidity, it often beats back the haze and vapours 
that come from the north, and renders the atmosphere dry and serene. 
In Greece and Italy the south wind is humid, because it comes di- 
rectly from the Mediterranean, bearing along with it much of the ex- 
halation from that sea. It blows, moreover, during the hottest 
weather, when bilious and pestilential fevers most frequently prevail. 
Hence its supposed connexion with those complaints. But it is not 
the south wind, it is the high temperature of the atmosphere, that 
contributes to produce the febrile miasm. Let hot air stream in from 
any other quarter, as it does from the north, in the southern hemisphere, 
and the issue will be the same. Malaria will be produced. Wind de- 
rives its character, not from the point of the compass from which it 
comes, but from the nature and condition of the surface over which it 
passes. Is that surface moist? So is the wind. Is it dry? The wind an- 



Caldwell on Malaria. 337 

swers to it. Hot? The wind is also hot. Cold? Again the wind corres- 
ponds. And it carries malaria along with it, and may be therefore call- 
ed pestilential, for a short distance after passing over a sickly morass. 
Such is the true philosophy of that meteor. On the Atlantic borders, 
in the United States, all winds from north-east to south-west, taking 
east in the semicircle, are humid ; and all in the opposite semicircle, 
from south-west to north-east are dry. The reason of this is obvious. 
The former come from the ocean, saturated with exhalation; and the 
latter arrive from the interior of the continent, exhausted of their 
humidity by a long journey over land. 

Dr. Lind speaks of a certain effect of the east wind on the eastern 
coast of England, in terms which prove him to have been more 
of a mere observer than of a philosopher. He says that this wind 
" raises a copious vapour from water, mud, and all marshy or damp 
places." And he insists that it does positively " raise" the vapour, 
and does not produce it in any other way; and that hence, that wind 
is peculiarly deleterious. An error grosser than this can scarcely be 
imagined. It is the counterpart of the belief, that the moisture 
which, in a hot day, settles on the outside of a bottle or pitcher, 
filled with cold water, has passed through the pores of the vessel, in 
the character of sweat. Hence, by the uninformed, it is believed 
that the vessel actually does sweat. The east wind does not " raise" 
vapours in the part of England referred to; it only renders visible those 
that are already raised. Coming immediately from the sea, it is cool 
and humid; and therefore robs the ascending exhalations of a portion 
of their caloric. The necessary effect of this is, to condense them 
immediately, and render them visible. On the west coast of England 
the east wind acts differently. By passing over the island it has 
lost a portion of its humidity, and received in return a portion of ca- 
loric. It is not therefore a condenser of exhalation arising from 
water, and does not reduce it to a visible form. On that coast, the 
west wind being more humid, is better fitted to produce a vapour* 
It is on the same principle, I say, that a bottle filled with any cold 
liquid, takes from the warm air in contact with it, a portion of its 
matter of heat, condenses the humidity it contains in a state of va- 
pour, and renders it visible in the form of water. 

Is there any particular period of the moon's revolution around the 
earth, at which bilious fever more usually makes its attack, than at 
others? Yes; at the times of her full and change. This is neither 
" hypothesis," nor " vision," although both terms have been affixed 
to it. It is a fact, as satisfactorily ascertained by observation, as any 
other connected with the complaint. The histoiy of epidemic di&* 



338 Caldwell on Malaria. 

eases, when circumstantially given, proves that attacks and deaths 
occur most numerously at, the periods referred to. Some of the mos: 
distinguished members of our profession have recorded their observa- 
tions to that effect. "Were my own testimony of any weight, I would 
say that it fully concurs with that of others, who advocate the doc- 
trine of lunar influence. Nor is the reason of this concealed. The 
vicissitudes in the sensible qualities of the atmosphere, which are 
greatest and most frequent about the times of the full and change of 
the moon, act as the exciting causes of the complaint, in those who 
are already predisposed to it. Am I asked for the names of any of 
the writers to whom I have referred as high authority on this subject? 
I answer the demand by mentioning Diemerbrock, Meade, Bal- 
four, Mosely, and Rush; and I could add twice as many more, 
were it necessary. The prophylactic precept founded on this doc- 
trine is plain, and not without its value. During the prevalence of 
an epidemic fever, let those who reside within the sphere of the ma- 
laria be especially cautious of exposure to the weather, about the 
periods of the full and change of the moon.* 

Are there any medicinal substances calculated to obviate the ef- 
fects of malaria? I know of none. All nostrums administered for 
that purpose, are but the fruits of empiricism. Some physicians 
speak with confidence of the beneficial effects of repeated purgatives 
in protecting the system from bilious fever. I consider the opinion 



* There is not, in the science of meteorology, a single fact that rests on a 
broader or more solid foundation, than that a great majority of the most sudden 
and striking changes which occur in the atmosphere, from heat to cold, and 
from moisture to dryness, and the reverse, and an equal majority of tornados, 
tempests, and other violent atmospherical commotions occur about the periods 
of the full and change of the moon. This truth is supported alike by the re- 
cords of the past, extending even to ancient times, and events that are con- 
stantly presenting themselves to our observation. That such vicissitudes in the 
atmosphere are uniformly prejudicial to the health of valetudinarians, is another 
fact which will not be controverted. But, during the prevalence of a bilious 
epidemic, every one exposed to the poison of it is so far valetudinary, as to be 
more than usually liable to disease. Exposure and unfriendly impressions of 
every kind, which would be innocent, at other times, produce sickness now. 
Such impressions are necessarily made by great and sudden changes in the 
sensible qualities of the atmosphere. It is on this ground that the atmospheri- 
cal vicissitudes, occurring about the times of the full and change of the moon, 
act as exciting causes, and aid in producing new cases of the disease. Of all 
other epidemics the same is true, for the same reason. Hence, during the pre* 
valence of every complaint of the kind, the same periods of the moon are most 
productive of fresh attacks. 



Caldwell on Malaria. 339 

unfounded, and the practice it recommends hazardous, not to say 
injurious. They are the growth of hypothesis. Sound science does 
not countenance them; and they derive no support from experience. 
Repeated purging, like the excess of any other evacuation, deranges 
the system, and enfeebles its conservative power. Instead of resist- 
ing, this invites disease. The alvine evacuations should be kept as 
nearly as possible in their state of habital regularity, Change would 
be much more likely to prove injurious than useful. Medicinal sub- 
stances are intended and suited, as their name imports, to restore 
health, when lost, not to sustain it when possessed. Let them be 
reserved therefore for actual indisposition, and then administered 
without loss of time, and with the skill and vigour required. Does 
constipation of the bowels occur? It threatens disease, if it is not 
the commencement of it, and should be promptly removed. But ac- 
tual and continued diarrhoea, the result of the repeated administra- 
tion of purgatives, is not the best substitute for it. Too much purg- 
ing is as bad as too little Let both be avoided. Ibis tutissimus 
medio, is here the precept of experience and wisdom. In fine, I say 
of the functions generally of the alimentary canal and the organs con- 
nected with it, as I did of diet and drink; let them be maintained in 
the condition that has been found most favourable to health and 
strength. As far as they are concerned, this will afford the best 
protection from disease. 

The use of bitters, Peruvian bark, and sundry other articles de- 
nominated tonics, has been recommended as a security against a pre- 
vailing bilious epidemic. This advice does not rest on any sound 
principle of hygiene, with which I am acquainted; nor, as far as I 
am informed, does experience testify to the success of the practice it 
enjoins. I cannot therefore confide in its efficacy. By inducing an 
unnatural state of things, I apprehend it would be ultimately injurious. 

A degree of cutaneous excitement somewhat preternatural, but not 
so high as to amount to disease, would seem to promise some security 
from bilious complaints. Children affected with prickly heat escape 
cholera infantum, unless from a sudden change in the atmosphere, or 
some other cause, the eruption disappear. The same is true of 
adults as relates to dysentery and bilious fever. Individuals who 
labour under elephantiasis are exempt from the fevers of hot climates; 
and the same is often the case with those who are troubled with cu- 
taneous ulcers. Lazars of this description rarely suffer from oriental 
plague. Such, I say, are the facts; and the philosophy of the cases 
must be sufficiently familiar to every physiologist. 

What then would be the effect of preternatural excitement cf the 



340 Henderson on Consumption. 

skin produced intentionally, as a means of prevention, during the 
prevalence of an epidemic fever? of one or two issues, or small per- 
petual blisters, for example; or of the irritation produced by tar- 
tarized antimony? These expedients I have never tried to such an 
extent as to enable me to speak of them from personal observation. 
But some of them are recommended on high authority. I shall only 
add, that they tend to the maintenance of centrifugal action, which 
is well calculated to prevent disease. Under proper regulation, 
therefore, they may possibly be found worthy of more attention than 
they have heretofore received. 

It was my intention to have expressed my opinion, with the grounds 
of it, on the subjects of the two following questions, w r hich are re- 
motely connected with some of those discussed in this Dissertation. 

1. Does the same malaria produce typhus and common bilious 
fever? 

2. Is the malaria productive of yellow fever the same with that 
which gives rise to intermittents and remittents; or is it a different 
form of miasm prepared from the same elements? 

In each case my present views would induce me to give a negative 
answer. I consider the malaria of typhus different from that of 
bilious fever, in both its nature and origin; nor, although formed 
from the same materials, do I believe the miasms of yellow and in- 
termitting fevers to be identical. But as the consideration of these 
points is not essential to the solution of the questions proposed by 
the Faculty of Maryland; and as I have already trespassed on the 
limits I had prescribed to myself in this inquiry, as well, I fear, as 
on the indulgence of the Faculty, I decline further discussion, and 
close my Dissertation. 



Art. II. Cases of Pulmonary Consumption, with Observations. By 
Thomas Henderson, M. D. Professor of the Theory and Practice 
of Medicine in the Columbian College, D. C. 

OASE I. —The subject of this case is a young lady, whose mother 
died of pulmonary consumption. The patient is sixteen years of age. 
It has been observed that consumption preys not " on the thorns and 
brambles of this wilderness, but on the rose and passion-flower of 
human excellence and gentleness." This was exemplified in the 
case of this lady. Apprehensive from her fragile delicacy of con- 
stitution that she would have phthisis, and attracted by her meek 



Henderson on Consumption* 341 

gentle disposition, and by her personal loveliness, her friends watched 
over her with a tenderness that sheltered her from every impression 
which could hazard either emotion of mind, or irritation of body. 
She was nurtured with all the vigilance and care required by the 
loveliest and most tender flower. Pulmonary irritation, notwith- 
standing, became evident, and this but redoubled the sedulous atten- 
tion of her friends. She kept her room, avoided exertion, had a long 
course of medical treatment. In her case there was no amelioration^ 
it proceeded steadily to a fatal termination. 

Case II. — Miss — « — , sister of the lady whose case has just been 
given, was for many years threatened with consumption. She had a 
very flat chest, cough, expectoration, great debility, pain in the side 
and breast* amenorrhcea, fluor albus. She became much emaciated, 
and all who knew her were assured that the hereditary family disease 
would soon terminate her existence. Nothing that affectionate soli- 
citude could secure was withheld. I attended her for a long time, 
endeavouring while I guarded against inflammatory action in the 
lungs, to prevent the increase of debility. Particular attention was 
given to avoid active exercise, or exposure to cold. Her health did 
not improve. Being sincerely pious, and desirous to practise what 
she professed, she insisted on attending evening prayer meetings, 
and on uniting with other institutions for benevolent purposes. These 
involved a change in her habits, against which J remonstrated, and 
in which she was opposed by her friends. She, however, gradually 
adopted her own course; took no medicine; went out at night, and 
exerted herself far beyond what was thought discreet. She improved 
in health; her mind became more cheerful; it was obvious that the 
change of habits had no unfavourable influence. The pulmonary 
symptoms declined. She married soon after, has children, and now 
enjoys good health, with every prospect of long life. 

Case III. — Mr. is the brother of the cases just related. ' He 

inherited a feeble, delicate frame, with striking resemblance to his 
mother, who died of phthisis. At eighteen, he had cough and pul- 
monary symptoms; but he entirely disregarded the monitions of here- 
ditary predisposition, the actual symptoms of breast complaint, as well 
as what might be anticipated from a very narrow chest, tall and 
slender frame. He was engaged in laborious duties in a dry-goods 
store; afterwards pursued a life of much more active exercise and 
exposure to all weather. He went two voyages to sea, and since fol- 
lows mercantile business that requires bodily and mental activity. 

No. XVI.— August, 1831. 30 



342 Henderson on Consumption. 

He preserved a good state of health for more than ten years. Of late 
he has had one attack of haemoptysis; but except for the time has not 
confined himself, and is recovering well from it. 

Case IV. — Miss r-" , " - 9 aged twenty, came under my care with 
many symptoms of tuberculous consumption, which disease had proved 
fatal to several members of her mother's family. My patient has 
hard cough, slight pain in the chest, expectoration of tough ash-co- 
loured mucus, great debility, pain in the loins, and there was an ir- 
ritable, frequent pulse. I was exceedingly apprehensive of the re- 
sult, and treated her case circumspectly in the way usually pursued 
by the best practitioners. She took digitalis, cicuta; was moderately 
bled, was blistered, and all this without benefit. Seeing that no re- 
lief was afforded by medicine, and that the prescribed cautions as to 
exposure and exertion denied her many of those enjoyments that a 
fine mind and cheerful spirit derived from social intercourse in visit- 
ing her friends, she gradually ceased consulting me* adopted her usual 
habits, and lost no health by giving up medicine. She travelled, 
married some time after, is the mother of several children, has pur- 
sued a very active life, and has no reason to apprehend a return of 
her symptoms. 

The four persons whose cases have been detailed, were near rela- 
tions. The first case submitted most rigidly to what was medically 
advised; she was closely housed, took much medicine, and yet the 
symptoms were not palliated, nor the fatal result procrastinated. In 
the other instances, strong predisposition to consumption; nay, actual 
symptoms were averted and removed by a course utterly at variance 
with what the physician advised. I do not mean to say that the same 
course would have removed the disease in the first case, for there are 
too many cases inevitably mortal. It is sufficient that the result of 
the three favourable cases be borne in mind, in reading the observa- 
tions at the close of this paper. 

Case V. — Doctor B , while a student of medicine, attracted 

my attention. His family has been severely visited with tuberculous 
phthisis. Within a year two brothers and one sister died of it. He 
had pulmonary symptoms, pain in the breast, cough; once spit blood, 
and his friends deeply feared that he would fall a victim to consump- 
tion. His brothers and sister were attended carefully by an eminent 
physician, who pursued the routine thought best for such cases; he 
adapted that routine with great intelligence to the several cases. I 
was consulted in two of the cases; no benefit resulted from medical 
treatment. Doctor B. was so situated as to be compelled to walk 



Henderson on Consumption. 343 

two miles every day to attend the medical lectures, and to return the 
same distance at evening. This he did with unvarying regularity, 
through all kinds of weather, and frequently remained in the dissect- 
ing room till late at night. Such was his ardour for the acquisition 
of medical knowledge, that though with the above symptoms and 
much debility, he exposed himself to weather cold and wet, and to 
fatigue that others shunned. Occasionally the pain in the chest and 
debility were alarming— but he took no notice of them, and con- 
tinued habits that / urged him to avoid. He, thus predisposed, con- 
tinued these habits for three winters, and now lives in finer health 
than he has ever enjoyed. His relations who died, carefully shunned 
exposure and exertion. 

Case VI. — Some years since I was called to see a gentleman, 
about twenty-two years of age. His father died of tracheal and tu- 
berculous phthisis, and my patient had for some time laboured under 
cough, purulent expectoration, hoarseness, pain in the breast. He 
had fever, with partial night sweats. I could not doubt, from his symp- 
toms and the attendant emaciation, that his disease was confirmed 
strumous consumption, and that it would soon terminate fatally. I 
prescribed various remedies, anti-hectics, mild tonics, bleeding twice 
for the pain, mucilaginous mixtures for the cough, blisters, &c. As 
the autumn approached, I endeavoured to impress on his mind my 
views of what should be his winter arrangements; and these views 
were founded on flannel and the fireside; particularly that he should 
avoid exposure to cold and wet weather. He promised obedience 
to my advice as to the use of medicine and exposure during the cold 
season. I paid great attention to his case and symptoms, but the 
treatment did him no good. As his duties required exposure, he 
finally became impatient; went out as I thought at great hazard; 
abandoned the use of medicine, and as he rapidly lost flesh, it seemed 
almost certain that he would not live long. I discontinued my visits, 
as he took nothing, and was imprudent. He would walk miles in the 
coldest weather without a surtout, and without flannel. He never 
avoided wet walking, or exposure to rain or snow. He took what diet 
was most agreeable to him; and now, after four years continuation of 
these habits, he is in much better health. The pulmonary symptoms are 
comparatively slight, and he apprehends no bad consequences from 
them. 

Case VII. — About two years since, at the close of winter, I was 
consulted by a gentleman who had pulmonary symptoms. He had 



344 Henderson on Consumption. 

cough, expectoration, pain in his breast, lost his flesh, his constitu- 
tion was delicate, his frame slender, and his chest narrow and stoop- 
ing. I blistered him, gave him cough mixtures, and confined him to 
his room until the weather became mild. As he did not recover, I 
advised him to go by sea to New York, to reside in the country, to 
take exercise freely, and to avoid medicine, unless it became ob- 
viously necessary. I had the pleasure to see my patient some time 
after with his symptoms entirely removed. Medicine had no agency 
in his recovery. 

Case VIII. — Mr. — -*■, a&tat. fourteen, lost his mother with tu- 
berculous phthisis. It deserves remark here, that his mother was 
one of a family of nine, every member of which family died of this 
phthisis. This youth was growing up with every appearance of the 
scrofulous aspect; strong symptoms of pulmonary disease came on; 
as cough, thoracic pain, and I am informed that he once had haemop- 
tysis. He was advised to adopt the life of a sailor, the laborious 
duties of a common sailor. He went out before the mast; and after 
having been two years at sea, seems to have a renovated constitution, 
and is free from the pulmonary symptoms that threatened his life. 

Case IX, — Mr. J lost his mother with tuberculous consump- 
tion. Seven years ago he had measles, which, as they declined, develop- 
ed pulmonary symptoms, cough, pain in the chest, expectoration of 
tough dark mucus. Ever since he has suffered with obvious symptoms 
of tuberculous consumption; during the winter they are distressing. 

He has taken no medicine, is bled when the lungs seem to be irritated, 
and when they occasion pain — and he has derived great benefit from 
issues. But he has pursued a regular plan of out-door exercise on 
horseback and in walking, in winter and in summer. He is now 
better than when first taken. He attends the medical lectures; dis- 
sects at late hours, and is confident that his habits have baffled the 
threatened inroads of a most formidable disease. He does not lose 
blood habitually— ponly when obvious local plethora demands it. 

I have been induced to review my experience in the treatment of 
phthisis pulmonalis, by reading two papers by Dr. Parrish, in the 
North American Medical and Surgical Journal. I could have ad- 
duced several other instances, but the above cases appear to me suf- 
ficient to justify some very interesting practical reflexions. These 
may be submitted in the form of queries. 

1. What has been the result in those cases of tuberculous phthises 



Henderson on Consumption, 345 

which have been subjected to deliberate and judicious medical treat- 
ment, unconnected with free exercise in the open air at all seasons? 

The answer is, that my long and extensive experience does not afford 
one case of recovery. 

2. Has the medical treatment, without active exercise, materially 
protracted life in any cases? 

The answer is, that it is very doubtful whether one life has been 
materially protracted. 

3. Have bleeding, digitalis, mercury, prussic acid, tartar emetic, 
confinement to stove rooms, blistering, emetics, cicuta, ipecacuanha, 
inhalations, liverwort, have any of these, without active exercise, 
arrested, averted, or cured one case? 

Confining this answer to tuberculous phthisis and to my own ex- 
perience, the answer is in the negative. 

4. Has any one case been averted, arrested, or cured, the success- 
ful result in which has not been owing to exercise, exertion, to free 
exposure to weather at all seasons, in walking, riding, and sailing? 

The answer is, that this course of habits seems to have been the 
only preventive or curative agent. 

5. And yet another question recurs, viz. in reviewing my practice, 
is there not reason to believe that many remedies so much relied on, 
and so authoritatively commended, have been either positively or 
negatively injurious, if not both? 

The answer to this question may be inferred from what follows. 
The subject should be cautiously investigated, but requires most se- 
rious consideration. 

If the opinions and experience of Dr. Parrish and others, and if 
the cases just detailed prove any thing, they demonstrate this, that 
many cases of phthisis that were in progress of medical treatment, 
and were doing badly; on discontinuing the medicine, and in relying 
on active exercise and plain nutritious diet, did well. It would ap- 
pear that a continuation of medical treatment in other cases did no 
good; the disease terminating certainly, and often speedily in death. 
This was probably owing to the intractable nature of the disease 
preying on constitutions unable to withstand its ravages. We should, 
however, inquire and reflect seriously, whether remedies, such as 
are used in consumption, if they be not beneficial, be not injurious. 
It is not probable that bleeding, mercury, digitalis, prussic acid, &c. 
will be negative in such a disease, and in such constitutions as the 
phthisical have. So uniform is their failure to cure, and so frequently 
are they injurious, that the routine of prescription is formal at best, 
And hazardous in many instances, This formality, this routinism, 



346 Henderson on Consumption. 

is the bane of improvement in our science; and Dr. Parrish. deserves 
the thanks of the profession for the firmness and intelligence with 
which he has assailed it. 

If it excite surprise when I say that not one recovery from phthisis 
has occurred in my experience, let it be observed that allusion is 
made to tuberculous consumption. Chronic bronchitis, catarrhal 
phthisis, and that from ordinary suppuration or abscess in the lungs 
are not in view. I have often seen recoveries in these cases, and 
have reasonably ascribed the recovery to medical treatment. Not so 
with tubercular phthisis. In this fell disease, if a remedy there be, 
it is yet to be discovered; and he is a wise practitioner who avoids 
the leedentia in scrofulous consumption. This form of phthisis is 
equally fatal wherever it exists; and where is it not? If in the ad- 
mission that the remedies used may have been positively injurious, 
there appear too much candour, it is replied, I have followed the best 
lights that have been supposed to gleam along the dark path of tuber- 
culous phthisis. 

Experience has long since taught me that the writings of Dr. Rush 
on pulmonary consumption are not so much to be relied on as his pre- 
cepts and practice in many other cases. The peculiar action of tu- 
bercular disease in the lungs, arising as it does from strumous com- 
plication, sets at nought the simplifications of ingenious hypothesis, 
and much more the boldness of systematic practice. Consumption 
consists in something more than the action of chronic pneumony, and 
invariably baffles the depletory measures directed to reduce that ac- 
tion. The origin, increase, and softening of tubercles, involve more in 
practical consideration, than the mere question whether or not they 
are the result of inflammation. It is in the incipient stage of tuber- 
culous phthisis that the practice of Rush is to be deprecated. It is 
to this incipient stage that the plan revived by Dr. Parrish is appli- 
cable, though not a few cases are on record in which the plan was 
advantageously pursued in more advanced stages. One of my patients 
appeared to be in confirmed consumption, and yet has been apparently 
preserved by this hardening system. 

There is one thing to be considered in the treatment of consump- 
tion, and it is very important. Take a patient threatened with this 
disease, or with it formed; confine him to his room; deny him active 
exertion; bleed him frequently; put him on low diet; prevent unre- 
served intercourse with his friends; give him mercury, digitalis, cicuta, 
hydrocyanic acid, and you surround him with a gloom that has most 
positive influence on his nervous system. Nervous depression and 
irritation derange, irritate, enfeeble vascular action, especially in the 



Henderson on Consumption* 347 

capillaries, and here is a superadded and exceedingly operative dif- 
ficulty. It is vain to talk to patients about exercise with dumb bells, 
&c. in stove rooms. Patients lose their energy by the confinement, 
and many lose entirely their elasticity and hope, in the fear that this 
course of practice and seclusion arises from the belief that consump- 
tion is formed, and therefore incurable. In all chronic cases, men- 
tal energy and cheerfulness are conspicuously subsidiary in treat- 
ment; without them our mercury, and foxglove, and bleeding, do 
harm rather than good. This system then of confinement so impairs 
nervous energy as to act unpropitiously on the bodily powers, on 
the capillary circulation in the abdomen, on the skin, and above all, 
in the lungs themselves, favouring obstructions and sluggish circula- 
tion there. I have heard a delicate female say, with great firmness, 
" if I have to live but two years, let me rather enjoy myself than be 
immured;" and pursuing her own course, she lives and does well. 

How different are the effects of accustomed exercise and habits on 
the nervous system, and by consequence, on general functional ac- 
tion. How exercise tends to equalize and invigorate capillary circula- 
tion, and thus to prevent local obstruction, and if used with judg- 
ment, to remove it when formed. Exposure to cold, is supposed, in 
phthisical and other cases, to act unfavourably in two ways; on the 
skin generally by constricting it, exciting sympathetically the irri- 
tatio introversaj and secondly, by direct impression on the air-cells 
of the lungs. The first mode of operation can be easily guarded 
against, by carefully adapting dress; while the injury from direct 
contact of air has always appeared to me to be hypothetical. Doubt- 
less if a person habituated to stove rooms too suddenly inhales a 
cold atmosphere, it may be prejudicial; but this sudden change is not 
here considered or desired. 

An objection to exercise is by some said to be, that it so hurries 
the circulation of blood through the lungs as to be prejudicial in tu- 
berculous phthisis. Of this I have strong doubt. Too great exertion 
may do so; but this is not what we wish the patient to make. On the 
contrary, moderate exercise regularly pursued on horseback or in a 
carriage, has to my knowledge reduced an irritable and frequent 
pulse in disease of the heart, to moderate and healthy action. I am 
sure that so far as exercise favours capillary circulation, it accom- 
plishes an important object in the incipient, or even in the more ad- 
vanced stages of phthisis. 

It has been observed by Dr. Parrish, that the practice sanctioned 
by his cases and by mine is not new. It is a practice which should be 
judiciously attempted and fairly tried by cautious perseverance. Let 



348 Henderson on Consumption. 

the patient keep the feet dry and warm; let him be so well clothed as 
to prevent sensations of chilliness; let him avoid those severities of 
weather that a man in health would shun; but after this let him take 
exercise in the open air, at first in the mode of gestation, then on 
horseback, and finally by walking. In winter let him go to a climate 
where there will be the least interruption to his active habits. In this 
case physic may be needed to remove painful incidental symptoms, 
and what this physic should be will be obvious. It may be that these 
habits, and the courses of remedies usually adopted, have been too 
much separated under the idea of their incompatibility. 

In coming to the conclusions apparently justified b} T the above ex- 
perience and reflexions, and sanctioned by the excellent judgment 
of Dr. Parrish, I have had much to contend with. A physician should 
cautiously abandon practice sanctioned by authority, and should cir- 
cumspectly enter on the field of experiment. Early education led me 
to rely much on medicine in phthisis. Facts, however, within my 
own experience, too numerous to be resisted, and too plain to be mis- 
taken, have caused me much anxious consideration. These facts are 
submitted, as they may be useful. If duly estimated I think they 
will not be considered as overrated. We know much of the patho- 
logy of tuberculous phthisis, perhaps as much as we can expect to 
know. Bayle, Portal, Young, Reid, Duncan, Southey, Rush, 
with many others, have illustrated every point in the range of con- 
sumption, except the cure. I have seen too many fatal cases, fatal 
after every effort that authority or reason sanctioned, to believe that 
we know any remedy that promises the least hope to the sufferer. 
"What then shall the physician do who has thus been baffled in hun- 
dreds of cases ? Let him listen to the candid intelligence and ex- 
perienced judgment of Dr. Parrish: let him test the practice, and 
confirm or confute the suggestion. 

Hippocrates sent his patients on foot to the walls of Megara— # 
Sydenham sent one on a long journey to see a Dr. Robinson. In 
rhetorical figure and in laudable hope, the physician has said, that 
in the wilds of the unexplored west, at the base of the Rocky Moun- 
tains, the plant may grow, the flower may bloom, the root may pe- 
netrate, that possesses the healing power over tuberculous consump* 
tion. If the views to be inferred from these imperfect remarks b§ 
correct, we may send our phthisical patients in pursuit of the ex* 
pected blessing. 

Washington, D. C. May, 1831, 



Horner's Account of a Double Female Foetus. 349 

Art. III. Account of a Double Female Foetus. By W. E. Horner, 
M. D. Adjunct Professor of Anatomy in the University of Penn- 
sylvania. [With a plate.] 

AN eminent practitioner in an adjoining state was called within a 
few months to assist Mrs. — — -, in labour with her third child. At 
4 o'clock, P. M. before his arrival, the membranes had ruptured. He 
found a head presentation, with the ordinary phenomena of labour, 
and the pains severe and frequent. At 7 o'clock the head of , the 
child protruded through the vagina and continued in that state till 
9 o'clock in the evening, at which period the mother was safely de- 
livered of a dead female child, the subject of this communication. 
This infant having been brought to me for examination, the follow- 
ing is the result of the dissection. 

External configuration.— The infant of ordinary size, having two 
heads and necks, one trunk, two upper and two lower extremities. 
The transverse diameter of the trunk was greater than usual. The 
head and neck which had presented first were tumid and highly in- 
jected with red blood, the latter having formed an extensive ecchy- 
mosis under the whole scalp between it and the pericranium: where- 
as the other foetus was pallid. 

Skeleton. — Two distinct lines of spinous processes of the verte- 
brae could be traced under the skin from the heads down to the pel- 
vis, and which upon further examination, by removing the soft parts 
were found to arise from two spines, perfectly distinct from one an- 
other, excepting the lumbar vertebrae which adhered laterally by 
their transverse processes, and the ossa sacra, which were fused to- 
gether like two sacra fixed edge to edge. The lower end of this dou- 
ble sacrum was bifid, and each fork had its own os coccygis. Each 
spine had its own distinct spinal marrow. 

There was but one sternum, which was broader than usual, and 
exhibited by the double points of ossification, a disposition to form a 
double bone. 

Allowance made for this state of the sternum and of the spines, 
there existed a total deficiency of the left side of the right skeleton 
and of the right side of the left skeleton, excepting the beginnings of 
the ribs on these defective sides. These ribs were distinct in both 
foetuses, being joined by ligament to their congeners, so that the ske- 
letons were united also by that arrangement, as well as by the ad- 
hesion of the lumbar vertebrae and of the sacra. The general me- 
chanism of these foetuses, resembled what would arise from cutting 
away the left side of one skeleton from the left shoulder to the sa- 



350 Homers Account of a Double Female Faztm. 

erum, and by cutting away the right side of another skeleton m 
the same relative line, and then uniting the two skeletons by the 
symphysis pubis — by a fusion of the sterna at their contiguous edges 
— by a fusion of the contiguous edges of the two sacra, and a liga- 
mentous adhesion of the contiguous stumps of ribs. 

Internal organization. — The anatomy of the necks was very ano- 
malous, adhering as they did laterally at their roots; we found the 
right sterno-hyoid muscle of the left fetus, and the left sterno-hyoid 
muscle of the right foetus, united together at their inferior ends, and 
forming a transverse muscle, (with a slight convexity downward,) 
running from one os hyoides to the other. The heart was placed in 
the neck, fairly above the sternum, and resting upon the upper end 
of the latter. , 

The heart, though but one body, evidently arose from the coali- 
tion of two hearts, one for each foetus. For instance, on its right 
side was a right auricle belonging to the right foetus, and to the 
left of this was a ventricle, from whose summit proceeded an aorta 
and a pulmonary artery for the right foetus. 

On the posterior side of the heart existed a middle auricle — the 
left internal jugular vein of the right subject, and the right internal 
jugular vein of the left subject, united into a common trunk, which 
discharged into this middle auricle. The latter was found to com- 
municate with the right auricle aforesaid. 

The left auricle of the left foetus communicated by a round hole 
with the right auricle of the right foetus; it also communicated by a 
hole above the former, with the middle auricle. The same left auri- 
cle had also an ostium venosum communicating with its left ventri- 
cle; from which left ventricle proceed the aorta of the left foetus. 

In front of the middle auricle was a middle ventricle, which sent 
off' the pulmonary artery of the left foetus, and also communicated 
with the middle auricle, and by a lateral opening with the ventricle 
of the right foetus. 

The summary of this arrangement is, that the three auricles com- 
municated with each other, and the middle auricle communicated 
with the three ventricles, so that notwithstanding the complexity of 
the arrangement, the circulation was kept up. The middle ventricle 
we infer corresponded with the right ventricle of the left subject, 
inasmuch as it sent off the pulmonary artery of the left subject. 

The thorax had three cavities-^one for the right foetus, a second 
belonging to the left foetus, and a third cavity, behind and below the 
heart, belonging equally to the two foetuses. There was consequently 
a right lung and a left lung as usual, and a third lung in the third ca- 



Horner's Account of a Double Female Foetus. 351 

vity, which lung had five lobes, and arose therefore evidently from 
the coalition of the two adjacent lungs of the different foetuses. The 
thorax was separated from the abdomen by a diaphragm. 

The cavity of the abdomen was single, but a disposition to dupli- 
city was manifested in several of its organs. 

The liver being one body, was convex on its upper side, and look- 
ed like a single liver, but on its under surface, the blending of two 
livers was perceptible in the increased number of its lobes, and also 
by there being on its middle a double gall-bladder, with a common 
duct from it, which duct terminated in two orifices, one for each duo- 
denum. 

There were two stomachs, one on the right and the other on the 
left, having their pyloric orifices pointed to each other. There were 
also two intestinal canals^ for from each stomach proceeded a line 
of small intestine which was continued through the duodenum, jeju- 
num, and the upper half of the ileum. These two lines adhered la- 
terally to each other like a double-barrel gun> the adhesion beginning 
at the upper end of the duodenum* and continuing to the lower end 
of the jejunum; the two intestinal tubes then separated, and conti- 
nued so one-half Way down the ilea — afterwards they adhered late- 
rally for two or three inches, and then blended into a single tube 
which terminated in the colon, in the right iliac region. From the 
single tube of the ileum, a short diverticulum arose, so as to exhibit 
again an effort at a double canal. 

The colon was single, was properly formed, and exhibited a pecu- 
liarity only in being much longer than usual, perhaps twice the natu- 
ral length* 

There were two pancreases, and but one spleen, which adhered to 
the larger end of the left stomach. 

There were two kidneys and they were unusually large, one being 
for the right foetus and the other for the left; they had their corres- 
ponding capsulae renales, and betwen the two latter existed a third. 

There were two abdominal aortas, one for each foetus, and which 
descended between the kidneys and between the two spines. These 
aortas became a common trunk above the pelvis; this trunk divided 
almost immediately into two branches, of which the left was by much 
the most considerable. The right branch being small, went only to 
the right side of the pelvis and the corresponding lower extremity, 
while the left branch, besides supplying the corresponding side of 
the pelvis, and lower extremity, was continued in a large trunk as 
the umbilical artery. This umbilical artery was the only one belong- 
ing to the umbilical cord, 



352 HaywarcPs Case of Tumour in the Neck. 

There was but one urinary bladder. 

The organs of generation were single, and exhibited no disposition 
to duplicity. 

A plate of the skeleton of this foetus will be found in company 
with this description. A minute reference to it would be perhaps 
useless, as the eye perceives at once its peculiarities. 

Philadelphia^ April, 1831. 



Art. IV. Case of a Tumour in the Neck, with an account of the 
Operation for its Removal. By George Hayward, M. D. one of 
the Surgeons of the Massachusetts General Hospital* 

1 HE following case may perhaps be thought worthy of publication. 
It owes its chief interest to the obscurity in which the character of 
the disease was involved; but as the event proved that a correct di- 
agnosis was formed, by giving the details of the case, others may 
possibly be aided in arriving at correct conclusions under similar cir- 
cumstances. 

A healthy, married woman, twenty-three years of age, came to the 
Massachusetts General Hospital, June 4th, 1830, on account of a tu- 
mour in the neck. She resided in the state of Maine, more than two 
hundred miles from Boston. She was the mother of one child, which 
was eight months old, and which was weaned at the time she left 
home. The tumour was situated in the right side of the neck, and 
was first discovered by her about four weeks since. It was examined 
by several physicians in her vicinity who pronounced it to be an 
aneurism, and advised her to go to Boston, and have an operation 
performed. The tumour, when first perceived, she thinks was nearly 
as large as at the time of her admission at the hospital,* it was about 
the size of a hen's egg. 

It was situated on the right side of the neck, along the inner edge 
of the sterno-mastoid muscle, partly covered by that muscle; but the 
portion next to the trachea had no other covering than the common 
integuments. A part dipped down under the clavicle and was cover- 
ed by that bone. 

There certainly were some reasons for thinking it an aneurism, 
either of the common carotid or of the arteria innominata. Its situa- 
tion favoured this opinion, especially when taken in connexion with 
its sudden appearance, and its great size when first noticed. It pul- 



Hay ward's Case of Tumour in the Neck. 353 

gated also so strongly that its pulsations could be seen across the 
room. When examined by the stethoscope, it gave that peculiar 
rough sound which is known to characterize aneurisms. But it should 
be observed, that this sound was not perceived unless the instrument 
was applied in one particular direction, that is, from without in- 
wards, so as to bring the tumour on to the carotid artery. It had 
also the general appearance of an aneurism; so much so in fact, that 
at the time of her admission into the hospital, it was not even sus- 
pected that it could be any thing else. 

But after several examinations, a different opinion was formed. 
It was found that the tumour was not compressible; no degree of 
force that it was thought prudent to apply to it diminished its size 
in the least. It was moveable under the skin, and rose and fell in 
the act of deglutition. The patient was not affected with dizziness, 
vertigo, or any other affections of the head, which are usually, if not 
always the attendants of carotid aneurism. With regard to its pul- 
sations too, these were not perceived when it was raised up from 
the carotid artery. 

Dr. Warren, who repeatedly examined it, came to the conclu- 
sion, that it was a tumour, not of an aneurismal character, and that 
its removal should be attempted. In both these opinions I fully con- 
curred; the patient suffered very much from dyspnoea, and found 
great difficulty in swallowing any thing but liquids, and was anxious 
to be rid of it, if it could be accomplished without putting her life at 
hazard. It was therefore determined to undertake the operation, 
which was performed on the 16th of June, in the following manner:-— 
An incision about two and a half inches in length was made di- 
rectly over the tumour, along the inner edge of the sterno-mastoid 
muscle. I then cautiously dissected through the outer coverings of 
the tumour, till a considerable portion of it was laid bare. In this 
state a better opinion could be formed of its true character. It was 
therefore examined at this stage of the operation with the utmost 
care, and the result of the examination went to confirm the opinion 
we had previously adopted. A needle with a strong ligature was 
passed through a part of the tumour, which enabled me, by having it 
moderately drawn, to raise it up from the deep situation